Individual
JACQUENITA S MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
HHA
Contact information
Practice address
11816 IOWA AVE, CLEVELAND, OH 44108-1563
(216) 526-7825
Mailing address
11816 IOWA AVE, CLEVELAND, OH 44108-1563
(216) 526-7825
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
123456789
OH
Other
Enumeration date
04/05/2023
Last updated
04/05/2023
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