Jevantrad Network LLC

Primary specialty

Health Service Clinic/CenterTaxonomy code 261QH0100X

Legal business name

JEVANTRAD NETWORK LLC

Practice address

9558 W Raymond St
Tolleson, AZ 85353-4554

Phone

(401) 261-9519

NPI assigned

Jul 8, 2024

Last updated

Jul 8, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Marion Ddamulira, DNPNPI 1205113495

Title

Nurse Practitioner

Phone

(401) 261-9519

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Marion Ddamulira, DNP

  • Family Nurse Practitioner
  • Glendale, AZ
  • NPI 1205113495
  Medicare reassignment Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1720396800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1720396800000",
    "number": "1710723994",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9558 W RAYMOND ST",
            "city": "TOLLESON",
            "state": "AZ",
            "postal_code": "853534554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9558 W RAYMOND ST",
            "city": "TOLLESON",
            "state": "AZ",
            "postal_code": "853534554",
            "telephone_number": "401-261-9519"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEVANTRAD NETWORK LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-07-08",
        "last_updated": "2024-07-08",
        "certification_date": "2024-07-08",
        "status": "A",
        "authorized_official_last_name": "DDAMULIRA",
        "authorized_official_first_name": "MARION",
        "authorized_official_title_or_position": "NURSE PRACTITIONER",
        "authorized_official_telephone_number": "401-261-9519",
        "authorized_official_credential": "DNP"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• D'Vonne Marie Isham, R.N.
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• Amara Jabateh, MANAGER/CO-OWNER
• Veliria Virginia Jackson, NURSE PRACTITIONER
• Jayla Home Behavioral Health LLC (Wood Home)
• Jezzob Behavioral Health, LLC
• Cruz Antonio Jimenez Jr.
• Patricia K Joe, RN
• Kristen Ann Johnson-Phelps Sr., MS
• Songhee Jones, PHARMD

• Health Service Clinic/Center in Tolleson, AZ
• Providers in Tolleson, AZ by specialty
• Health Service Clinic/Center in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.