Provider Demographics
NPI:1033863576
Name:JAMERSON, PORCHE
Entity Type:Individual
Prefix:
First Name:PORCHE
Middle Name:
Last Name:JAMERSON
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 1:4289 E 133RD ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44105-6401
Mailing Address - Country:US
Mailing Address - Phone:216-541-3003
Mailing Address - Fax:
Practice Address - Street 1:4289 E 133RD ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44105-6401
Practice Address - Country:US
Practice Address - Phone:216-541-3003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-03
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health