Provider Demographics
NPI:1326746470
Name:KRAVCHUK, STANISLAV
Entity Type:Individual
Prefix:
First Name:STANISLAV
Middle Name:
Last Name:KRAVCHUK
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 1:6290 E LEMHI CT
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83687-9177
Mailing Address - Country:US
Mailing Address - Phone:208-509-9400
Mailing Address - Fax:
Practice Address - Street 1:6290 E LEMHI CT
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83687-9177
Practice Address - Country:US
Practice Address - Phone:208-509-9400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-17
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
No374U00000XNursing Service Related ProvidersHome Health Aide
No171400000XOther Service ProvidersHealth & Wellness Coach