Provider Demographics
NPI:1073110706
Name:STUART, PARISIA KANDICE
Entity Type:Individual
Prefix:
First Name:PARISIA
Middle Name:KANDICE
Last Name:STUART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PARISIA
Other - Middle Name:KANDICE
Other - Last Name:STUART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12736 LORAIN AVE # A
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44111-2609
Mailing Address - Country:US
Mailing Address - Phone:216-855-7971
Mailing Address - Fax:
Practice Address - Street 1:12736 LORAIN AVE # A
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111-2609
Practice Address - Country:US
Practice Address - Phone:216-855-7971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-06
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH501077010206376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide