Provider Demographics
NPI:1225508237
Name:RUBIN, CHYANNE R
Entity Type:Individual
Prefix:
First Name:CHYANNE
Middle Name:R
Last Name:RUBIN
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 1:15112 EUCLID AVE APT 108
Mailing Address - Street 2:
Mailing Address - City:EAST CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44112-2833
Mailing Address - Country:US
Mailing Address - Phone:216-242-7093
Mailing Address - Fax:
Practice Address - Street 1:15112 EUCLID AVE APT 108
Practice Address - Street 2:
Practice Address - City:EAST CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44112-2833
Practice Address - Country:US
Practice Address - Phone:216-242-7093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-03
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401898820916376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide