Provider Demographics
NPI:1386810893
Name:POLLARD, IREDA (STNA)
Entity type:Individual
Prefix:
First Name:IREDA
Middle Name:
Last Name:POLLARD
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3369 E 49TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44127-1645
Mailing Address - Country:US
Mailing Address - Phone:216-206-0041
Mailing Address - Fax:
Practice Address - Street 1:11607 EUCLID AVE
Practice Address - Street 2:APT 406
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-4394
Practice Address - Country:US
Practice Address - Phone:216-795-1107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400093200302376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2813450Medicaid