Provider Demographics
NPI:1003958562
Name:CERCEK, CHRISTINE MARIE (INDPENDENT PROVIDER)
Entity Type:Individual
Prefix:MISS
First Name:CHRISTINE
Middle Name:MARIE
Last Name:CERCEK
Suffix:
Gender:F
Credentials:INDPENDENT PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2787 SYLVIA AVE
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:OH
Mailing Address - Zip Code:44047-9774
Mailing Address - Country:US
Mailing Address - Phone:440-275-3434
Mailing Address - Fax:440-275-3434
Practice Address - Street 1:2787 SYLVIA AVE
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:OH
Practice Address - Zip Code:44047-9774
Practice Address - Country:US
Practice Address - Phone:440-275-3434
Practice Address - Fax:440-275-3434
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide