Provider Demographics
NPI:1295368769
Name:WASHINGTON, MARKETTA TRIKELLA (STNA)
Entity Type:Individual
Prefix:
First Name:MARKETTA
Middle Name:TRIKELLA
Last Name:WASHINGTON
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 1:11402 MCCRACKEN RD
Mailing Address - Street 2:
Mailing Address - City:GARFIELD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44125-2841
Mailing Address - Country:US
Mailing Address - Phone:216-459-5446
Mailing Address - Fax:
Practice Address - Street 1:11402 MCCRACKEN RD
Practice Address - Street 2:
Practice Address - City:GARFIELD HTS
Practice Address - State:OH
Practice Address - Zip Code:44125-2841
Practice Address - Country:US
Practice Address - Phone:216-459-5446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-12
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH379345141000376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide