Provider Demographics
NPI:1710252358
Name:DISMON, JESSE LEON SR
Entity Type:Individual
Prefix:MR
First Name:JESSE
Middle Name:LEON
Last Name:DISMON
Suffix:SR
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 1:1718 GLENMONT RD # 1
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-1135
Mailing Address - Country:US
Mailing Address - Phone:216-548-7140
Mailing Address - Fax:
Practice Address - Street 1:1718 GLENMONT RD # 1
Practice Address - Street 2:
Practice Address - City:CLEVELAND HTS
Practice Address - State:OH
Practice Address - Zip Code:44118-1135
Practice Address - Country:US
Practice Address - Phone:216-548-7140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-15
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH096091164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse