Healthcare Provider Details

I. General information

NPI: 1356624001
Provider Name (Legal Business Name): JAKIRA SIMONE CURRY STNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2011
Last Update Date: 09/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24451 LAKE SHORE BLVD APT.1019
EUCLID OH
44123-1272
US

IV. Provider business mailing address

24451 LAKE SHORE BLVD APT.1019
EUCLID OH
44123-1272
US

V. Phone/Fax

Practice location:
  • Phone: 216-732-0725
  • Fax:
Mailing address:
  • Phone: 216-732-0725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number400967410809
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: