Provider Demographics
NPI:1114794849
Name:MIROSHNICHENKO, KSENIA V
Entity Type:Individual
Prefix:
First Name:KSENIA
Middle Name:V
Last Name:MIROSHNICHENKO
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 1:1421 PIPER CT NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44703-1108
Mailing Address - Country:US
Mailing Address - Phone:330-415-3245
Mailing Address - Fax:
Practice Address - Street 1:1421 PIPER CT NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44703-1108
Practice Address - Country:US
Practice Address - Phone:330-415-3245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No372600000XNursing Service Related ProvidersAdult Companion