Provider Demographics
NPI:1558098814
Name:VAKLINA, EDITA B
Entity Type:Individual
Prefix:
First Name:EDITA
Middle Name:B
Last Name:VAKLINA
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 1:3708 LAKESIDE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-5371
Mailing Address - Country:US
Mailing Address - Phone:775-826-9008
Mailing Address - Fax:
Practice Address - Street 1:3708 LAKESIDE DR STE 200
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-5371
Practice Address - Country:US
Practice Address - Phone:775-826-9008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-05
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant