Provider Demographics
NPI:1235975012
Name:KOSTIV, INNA
Entity type:Individual
Prefix:
First Name:INNA
Middle Name:
Last Name:KOSTIV
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6841 DAY DR APT 628
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44129-5459
Mailing Address - Country:US
Mailing Address - Phone:216-413-6156
Mailing Address - Fax:
Practice Address - Street 1:6841 DAY DR APT 628
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-5459
Practice Address - Country:US
Practice Address - Phone:216-413-6156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide