MEDICARE: JAMESHIA GORDAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376K00000X	Nurse's Aide

General Provider Information

NPI Number	:	1902496409
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMESHIA GORDAN

Provider Business Mailing Address
First Line	:	2903 MINNIE AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44104-4040
Country	:	US
Telephone Number	:	216-246-6502
Fax Number	:

Provider Business Practice Location Address
First Line	:	2903 MINNIE AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44104-4040
Country	:	US
Telephone Number	:	216-246-6502
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/19/2021
Last Update Date	:	01/19/2021

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Directions to “ JAMESHIA GORDAN ” Practice Location

Language	Start Address	Practice Location

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