Provider Demographics
NPI:1770310419
Name:NORRIS, KIE-ARRA SHANAE
Entity type:Individual
Prefix:
First Name:KIE-ARRA
Middle Name:SHANAE
Last Name:NORRIS
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 1:24134 EUCLID AVE APT A1
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-1717
Mailing Address - Country:US
Mailing Address - Phone:216-710-9486
Mailing Address - Fax:
Practice Address - Street 1:24134 EUCLID AVE APT A1
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44117-1717
Practice Address - Country:US
Practice Address - Phone:216-710-9486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH602814580624251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care