Provider Demographics
NPI:1639930944
Name:VLASOV, EVGENII
Entity Type:Individual
Prefix:
First Name:EVGENII
Middle Name:
Last Name:VLASOV
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:378 SPRINGBORO LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-4666
Mailing Address - Country:US
Mailing Address - Phone:614-702-0824
Mailing Address - Fax:
Practice Address - Street 1:378 SPRINGBORO LN
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-4666
Practice Address - Country:US
Practice Address - Phone:614-702-0824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No374U00000XNursing Service Related ProvidersHome Health Aide