Provider Demographics
NPI:1508222563
Name:EARLY, JEMILA DANIELLE (CSFA)
Entity Type:Individual
Prefix:
First Name:JEMILA
Middle Name:DANIELLE
Last Name:EARLY
Suffix:
Gender:F
Credentials:CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23101 CORALBERRY WAY
Mailing Address - Street 2:
Mailing Address - City:CALIFORNIA
Mailing Address - State:MD
Mailing Address - Zip Code:20619-2193
Mailing Address - Country:US
Mailing Address - Phone:254-768-6982
Mailing Address - Fax:
Practice Address - Street 1:23101 CORALBERRY WAY
Practice Address - Street 2:
Practice Address - City:CALIFORNIA
Practice Address - State:MD
Practice Address - Zip Code:20619-2193
Practice Address - Country:US
Practice Address - Phone:254-768-6982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-06
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant