Provider Demographics
NPI:1144071226
Name:MUKHODINOVA, ANTONINA
Entity type:Individual
Prefix:
First Name:ANTONINA
Middle Name:
Last Name:MUKHODINOVA
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 1:1053 TERRA LN
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:OH
Mailing Address - Zip Code:44001-1149
Mailing Address - Country:US
Mailing Address - Phone:440-396-0086
Mailing Address - Fax:
Practice Address - Street 1:6143 GOLDENROD LN
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-4371
Practice Address - Country:US
Practice Address - Phone:216-379-2469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-28
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.107416.MEDS164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse