Provider Demographics
NPI:1477344984
Name:GREGOV, IVANA (RN, BSN)
Entity type:Individual
Prefix:
First Name:IVANA
Middle Name:
Last Name:GREGOV
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3628 WALNUT HILLS AVE STE 112
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-4484
Mailing Address - Country:US
Mailing Address - Phone:440-856-5209
Mailing Address - Fax:440-856-5209
Practice Address - Street 1:3628 WALNUT HILLS AVE STE 112
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-4484
Practice Address - Country:US
Practice Address - Phone:440-856-5209
Practice Address - Fax:440-856-5209
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-14
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.495714261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health