Provider Demographics
NPI:1407570401
Name:DUCK, CHANELL JOMAYE
Entity Type:Individual
Prefix:
First Name:CHANELL
Middle Name:JOMAYE
Last Name:DUCK
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 1:1145 CADILLAC BLVD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44320-2860
Mailing Address - Country:US
Mailing Address - Phone:234-303-6885
Mailing Address - Fax:
Practice Address - Street 1:1145 CADILLAC BLVD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44320-2860
Practice Address - Country:US
Practice Address - Phone:234-303-6885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker