Provider Demographics
NPI:1518356864
Name:GRABOVAC, IRENE CHRYSSOVALANTOU (NP)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:CHRYSSOVALANTOU
Last Name:GRABOVAC
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:IRENE
Other - Middle Name:
Other - Last Name:NIKOKIRAKIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:26908 DETROIT RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-2398
Mailing Address - Country:US
Mailing Address - Phone:440-892-6406
Mailing Address - Fax:440-617-0884
Practice Address - Street 1:2535 HALE ST
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:OH
Practice Address - Zip Code:44011-1856
Practice Address - Country:US
Practice Address - Phone:440-934-8810
Practice Address - Fax:440-934-8811
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-09
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH15784-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0117875Medicaid
OH0117875Medicaid