Organization
JACKIE EZELL
Active
Organization
JACKIE EZELL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACKIE DENESE EZELL (INDEPENDENT PROVIDER)
330787575431
Entity
Organization
Contact information
Practice address
516 GRIFFITH ST UNIT 401, YOUNGSTOWN, OH 44510-2604
(330) 787-5754
Mailing address
516 GRIFFITH ST UNIT 401, YOUNGSTOWN, OH 44510-2604
(330) 787-5754
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2858760
—
OH
Enumeration date
06/23/2014
Last updated
06/23/2014
Update your record
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