Provider Demographics
NPI:1184122871
Name:CIANCIOLA, RENA L I
Entity type:Individual
Prefix:
First Name:RENA
Middle Name:L
Last Name:CIANCIOLA
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RENA
Other - Middle Name:
Other - Last Name:CIANCIOLA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:521 WESTERN PL
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515-3507
Mailing Address - Country:US
Mailing Address - Phone:330-503-2119
Mailing Address - Fax:
Practice Address - Street 1:521 WESTERN PL
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515-3507
Practice Address - Country:US
Practice Address - Phone:330-593-2119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-27
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH85-2516089Medicaid