Healthcare Provider Details

I. General information

NPI: 1346911799
Provider Name (Legal Business Name): LATONYA DENISE SYKES-JACKSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2021
Last Update Date: 09/24/2021
Certification Date: 09/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26777 LORAIN RD STE 320
NORTH OLMSTED OH
44070-3225
US

IV. Provider business mailing address

26777 LORAIN RD STE 320
NORTH OLMSTED OH
44070-3225
US

V. Phone/Fax

Practice location:
  • Phone: 216-798-5558
  • Fax:
Mailing address:
  • Phone: 216-798-5558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN284266
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: