Individual
MS. IRA-ETTA MARIE BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
2200 E 106TH ST, APT #4, CLEVELAND, OH 44106-4258
(216) 229-8882
Mailing address
2200 E 106TH ST, APT #4, CLEVELAND, OH 44106-4258
(216) 229-8882
Taxonomy
Speciality
Code
Description
License number
State
163WC0400X
Case Management Registered Nurse
Primary
RN237736
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2631610
—
OH
Enumeration date
09/18/2008
Last updated
09/18/2008
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