Provider Demographics
NPI:1285220236
Name:NORWOOD-DAVIS, ELEANORA
Entity Type:Individual
Prefix:
First Name:ELEANORA
Middle Name:
Last Name:NORWOOD-DAVIS
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 1:13808 REXWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:GARFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44105-7010
Mailing Address - Country:US
Mailing Address - Phone:216-287-2145
Mailing Address - Fax:
Practice Address - Street 1:4300 MARTIN LUTHER KING JR DR
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44105-6208
Practice Address - Country:US
Practice Address - Phone:216-287-2145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-14
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver