Provider Demographics
NPI:1558187021
Name:JONES, BRIANNA ANTONICE (CPD, CLD)
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:ANTONICE
Last Name:JONES
Suffix:
Gender:F
Credentials:CPD, CLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4106 LEE RD REAR C
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44128-2181
Mailing Address - Country:US
Mailing Address - Phone:216-598-2828
Mailing Address - Fax:
Practice Address - Street 1:4106 LEE RD REAR C
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44128-2181
Practice Address - Country:US
Practice Address - Phone:216-598-2828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-29
Last Update Date:2024-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor