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NPI Code Detail

MEDICARE: IRENE CHRYSSOVALANTOU GRABOVAC NP

MEDICARE: IRENE CHRYSSOVALANTOU GRABOVAC NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner15784-NPOH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1518356864
Entity Type Code : Individual
Provider Name (Legal Business Name) : IRENE CHRYSSOVALANTOU GRABOVAC NP
Provider Business Mailing Address
First Line : 26908 DETROIT RD
Second Line : SUITE 301
City : WESTLAKE
State : OH
Zip : 44145-2398
Country : US
Telephone Number : 440-892-6406
Fax Number : 440-617-0884
Provider Business Practice Location Address
First Line : 2535 HALE ST
Second Line :
City : AVON
State : OH
Zip : 44011-1856
Country : US
Telephone Number : 440-934-8810
Fax Number : 440-934-8811
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/09/2015
Last Update Date : 06/16/2023

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