Provider Demographics
NPI:1629299714
Name:DZHAUN, INESSA A
Entity Type:Individual
Prefix:MRS
First Name:INESSA
Middle Name:A
Last Name:DZHAUN
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 1:222 RALPH CT NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708-4962
Mailing Address - Country:US
Mailing Address - Phone:330-454-4689
Mailing Address - Fax:330-454-4689
Practice Address - Street 1:222 RALPH CT NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-4962
Practice Address - Country:US
Practice Address - Phone:330-454-4689
Practice Address - Fax:330-454-4689
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
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
OH2330945Medicaid