Healthcare Provider Details

I. General information

NPI: 1629299714
Provider Name (Legal Business Name): MRS. INESSA A DZHAUN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 RALPH CT NW
CANTON OH
44708-4962
US

IV. Provider business mailing address

222 RALPH CT NW
CANTON OH
44708-4962
US

V. Phone/Fax

Practice location:
  • Phone: 330-454-4689
  • Fax: 330-454-4689
Mailing address:
  • Phone: 330-454-4689
  • Fax: 330-454-4689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: