Provider Demographics
NPI:1083973424
Name:MIREE, JARREAU DIAMOND (STNA)
Entity Type:Individual
Prefix:
First Name:JARREAU
Middle Name:DIAMOND
Last Name:MIREE
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2387 LEE RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-3423
Mailing Address - Country:US
Mailing Address - Phone:216-952-7742
Mailing Address - Fax:
Practice Address - Street 1:2387 LEE RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND HTS
Practice Address - State:OH
Practice Address - Zip Code:44118-3423
Practice Address - Country:US
Practice Address - Phone:216-952-7742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-04
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401411270712376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide