Provider Demographics
NPI:1851029250
Name:DERKACH, IRINA
Entity Type:Individual
Prefix:MRS
First Name:IRINA
Middle Name:
Last Name:DERKACH
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 1:232 TIMOTHY DR
Mailing Address - Street 2:
Mailing Address - City:NICHOLASVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40356-9514
Mailing Address - Country:US
Mailing Address - Phone:859-913-1082
Mailing Address - Fax:
Practice Address - Street 1:232 TIMOTHY DR
Practice Address - Street 2:
Practice Address - City:NICHOLASVILLE
Practice Address - State:KY
Practice Address - Zip Code:40356-9514
Practice Address - Country:US
Practice Address - Phone:859-913-1082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-12
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist