Provider Demographics
NPI:1578009957
Name:RADASHEVSKIY, MARIANA
Entity type:Individual
Prefix:
First Name:MARIANA
Middle Name:
Last Name:RADASHEVSKIY
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 1:6115 RIVERHAWK LN
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-3719
Mailing Address - Country:US
Mailing Address - Phone:509-212-2872
Mailing Address - Fax:
Practice Address - Street 1:6115 RIVERHAWK LN
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-3719
Practice Address - Country:US
Practice Address - Phone:509-212-2872
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-10
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide