Provider Demographics
NPI:1598220196
Name:KRKIC, MENSURA (LAC)
Entity Type:Individual
Prefix:
First Name:MENSURA
Middle Name:
Last Name:KRKIC
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 EAST AVE
Mailing Address - Street 2:
Mailing Address - City:TALLMADGE
Mailing Address - State:OH
Mailing Address - Zip Code:44278-2311
Mailing Address - Country:US
Mailing Address - Phone:330-633-1909
Mailing Address - Fax:330-633-2823
Practice Address - Street 1:168 EAST AVE
Practice Address - Street 2:
Practice Address - City:TALLMADGE
Practice Address - State:OH
Practice Address - Zip Code:44278-2311
Practice Address - Country:US
Practice Address - Phone:330-633-1909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-07
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH65.000350171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist