Provider Demographics
NPI:1023860426
Name:VON KROSIGK, IRINA ALEXANDROVNA
Entity type:Individual
Prefix:
First Name:IRINA
Middle Name:ALEXANDROVNA
Last Name:VON KROSIGK
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 1:826 COMANCHE LN
Mailing Address - Street 2:
Mailing Address - City:TIPP CITY
Mailing Address - State:OH
Mailing Address - Zip Code:45371-1512
Mailing Address - Country:US
Mailing Address - Phone:937-232-0232
Mailing Address - Fax:
Practice Address - Street 1:826 COMANCHE LN
Practice Address - Street 2:
Practice Address - City:TIPP CITY
Practice Address - State:OH
Practice Address - Zip Code:45371-1512
Practice Address - Country:US
Practice Address - Phone:937-232-0232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker