Provider Demographics
NPI:1851051130
Name:MALDONADO, IMARI ANN
Entity Type:Individual
Prefix:
First Name:IMARI
Middle Name:ANN
Last Name:MALDONADO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:IMARI
Other - Middle Name:ANN
Other - Last Name:MALDONADO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:440 10TH ST
Mailing Address - Street 2:
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-7033
Mailing Address - Country:US
Mailing Address - Phone:440-381-9986
Mailing Address - Fax:
Practice Address - Street 1:675 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-3602
Practice Address - Country:US
Practice Address - Phone:440-381-9986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-28
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty