Provider Demographics
NPI:1821406638
Name:MIRONENKO, IRYNA
Entity Type:Individual
Prefix:
First Name:IRYNA
Middle Name:
Last Name:MIRONENKO
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 1:230 QUENTIN RD
Mailing Address - Street 2:#B1
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-1450
Mailing Address - Country:US
Mailing Address - Phone:347-374-4304
Mailing Address - Fax:
Practice Address - Street 1:230 QUENTIN RD
Practice Address - Street 2:#B1
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-1450
Practice Address - Country:US
Practice Address - Phone:347-374-4304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-24
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY663513163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse