Provider Demographics
NPI:1326654492
Name:MLYNEK, RAYMOND
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:
Last Name:MLYNEK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67256 WILLOW GROVE RD
Mailing Address - Street 2:
Mailing Address - City:ST CLAIRSVLE
Mailing Address - State:OH
Mailing Address - Zip Code:43950-9271
Mailing Address - Country:US
Mailing Address - Phone:740-695-4732
Mailing Address - Fax:
Practice Address - Street 1:67256 WILLOW GROVE RD
Practice Address - Street 2:
Practice Address - City:ST CLAIRSVLE
Practice Address - State:OH
Practice Address - Zip Code:43950-9271
Practice Address - Country:US
Practice Address - Phone:174-069-5473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant