Healthcare Provider Details

I. General information

NPI: 1841101680
Provider Name (Legal Business Name): NOVA CRAFT RENOVATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2026
Last Update Date: 09/12/2026
Certification Date: 09/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208500 DERBY AVE
MARSHFIELD WI
54449-4295
US

IV. Provider business mailing address

206 W 3RD ST UNIT B
MARSHFIELD WI
54449-2706
US

V. Phone/Fax

Practice location:
  • Phone: 715-383-9274
  • Fax:
Mailing address:
  • Phone: 715-240-0727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: BOHDAN KORNIIENKO
Title or Position: GENERAL CONTRACTOR
Credential:
Phone: 715-383-9274