Provider Demographics
NPI:1235871054
Name:GRINBERG, EVGENIA
Entity Type:Individual
Prefix:
First Name:EVGENIA
Middle Name:
Last Name:GRINBERG
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 1:5465 N WOODS LN
Mailing Address - Street 2:
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-1199
Mailing Address - Country:US
Mailing Address - Phone:216-255-4907
Mailing Address - Fax:
Practice Address - Street 1:5465 N WOODS LN
Practice Address - Street 2:
Practice Address - City:SOLON
Practice Address - State:OH
Practice Address - Zip Code:44139-1199
Practice Address - Country:US
Practice Address - Phone:216-255-4907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-12
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0031096363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner