Healthcare Provider Details

I. General information

NPI: 1366859571
Provider Name (Legal Business Name): STEPHANIE DANEAN JEMISON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2014
Last Update Date: 07/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3440 RUMSON RD
CLEVELAND HEIGHTS OH
44118-1357
US

IV. Provider business mailing address

3440 RUMSON RD
CLEVELAND HEIGHTS OH
44118-1357
US

V. Phone/Fax

Practice location:
  • Phone: 216-336-2831
  • Fax:
Mailing address:
  • Phone: 216-336-2831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: