Provider Demographics
NPI:1275239279
Name:NORMAN, DAMON JERROD
Entity Type:Individual
Prefix:MR
First Name:DAMON
Middle Name:JERROD
Last Name:NORMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1923 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44004-2839
Mailing Address - Country:US
Mailing Address - Phone:208-651-4919
Mailing Address - Fax:
Practice Address - Street 1:1923 W 5TH ST
Practice Address - Street 2:
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-2839
Practice Address - Country:US
Practice Address - Phone:208-651-4919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-01
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant