Provider Demographics
NPI:1083263842
Name:SIERRA, JOAN
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:SIERRA
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 1:3304 PERSIMMON LN
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:OH
Mailing Address - Zip Code:44011-3708
Mailing Address - Country:US
Mailing Address - Phone:440-610-7598
Mailing Address - Fax:
Practice Address - Street 1:3304 PERSIMMON LN
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:OH
Practice Address - Zip Code:44011-3708
Practice Address - Country:US
Practice Address - Phone:440-610-7598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-05
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2930725374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide