Provider Demographics
NPI:1346466778
Name:KINNEY, LAREESA DENISE (PROVIDER)
Entity Type:Individual
Prefix:MS
First Name:LAREESA
Middle Name:DENISE
Last Name:KINNEY
Suffix:
Gender:F
Credentials:PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 DIVISION AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44113-2617
Mailing Address - Country:US
Mailing Address - Phone:216-737-0499
Mailing Address - Fax:
Practice Address - Street 1:2701 DIVISION AVE APT 591
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44113-2617
Practice Address - Country:US
Practice Address - Phone:216-737-0499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide