Provider Demographics
NPI:1134881220
Name:NOFFA, VICKI LASONJA
Entity type:Individual
Prefix:
First Name:VICKI
Middle Name:LASONJA
Last Name:NOFFA
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 1:2352 BELVOIR BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTH EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44121-1206
Mailing Address - Country:US
Mailing Address - Phone:216-450-9608
Mailing Address - Fax:
Practice Address - Street 1:2352 BELVOIR BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44121-1206
Practice Address - Country:US
Practice Address - Phone:216-450-9608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-06
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty