Provider Demographics
NPI:1306377098
Name:ESPIE, DONTAIVEAN
Entity Type:Individual
Prefix:MR
First Name:DONTAIVEAN
Middle Name:
Last Name:ESPIE
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 1:14014 BALDWIN AVE
Mailing Address - Street 2:
Mailing Address - City:EAST CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44112-2548
Mailing Address - Country:US
Mailing Address - Phone:216-303-1195
Mailing Address - Fax:
Practice Address - Street 1:14014 BALDWIN AVE
Practice Address - Street 2:
Practice Address - City:EAST CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44112-2548
Practice Address - Country:US
Practice Address - Phone:216-303-1195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-23
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0202272374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0202272Medicaid