Provider Demographics
NPI:1821364803
Name:LESURE, RUBY NATINA (STNA)
Entity type:Individual
Prefix:MS
First Name:RUBY
Middle Name:NATINA
Last Name:LESURE
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:MS
Other - First Name:RUBY
Other - Middle Name:NATINA
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:STNA
Mailing Address - Street 1:8259 OLDE 8 RD
Mailing Address - Street 2:SUITE#304
Mailing Address - City:NORTHFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44067-3700
Mailing Address - Country:US
Mailing Address - Phone:216-551-4906
Mailing Address - Fax:
Practice Address - Street 1:8259 OLDE 8 RD
Practice Address - Street 2:SUITE#304
Practice Address - City:NORTHFIELD
Practice Address - State:OH
Practice Address - Zip Code:44067-3700
Practice Address - Country:US
Practice Address - Phone:216-551-4906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-24
Last Update Date:2012-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400439611204376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide