Provider Demographics
NPI:1003669318
Name:EPPERSON, ANNETTE REGINA
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:REGINA
Last Name:EPPERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11400 APACHE DR APT 202
Mailing Address - Street 2:
Mailing Address - City:PARMA HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-9017
Mailing Address - Country:US
Mailing Address - Phone:216-832-5888
Mailing Address - Fax:
Practice Address - Street 1:11400 APACHE DR APT 202
Practice Address - Street 2:
Practice Address - City:PARMA HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-9017
Practice Address - Country:US
Practice Address - Phone:216-832-5888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374U00000X
374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health Aide