Provider Demographics
NPI:1629025291
Name:PROVCHY, JANICE MAE (IP)
Entity Type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:MAE
Last Name:PROVCHY
Suffix:
Gender:F
Credentials:IP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:93 FERNWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BARBERTON
Mailing Address - State:OH
Mailing Address - Zip Code:44203-1311
Mailing Address - Country:US
Mailing Address - Phone:330-753-2304
Mailing Address - Fax:
Practice Address - Street 1:3165 OSER RD
Practice Address - Street 2:
Practice Address - City:NORTON
Practice Address - State:OH
Practice Address - Zip Code:44203-5618
Practice Address - Country:US
Practice Address - Phone:330-825-1691
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2191962Medicaid