Provider Demographics
NPI:1740810357
Name:MEYKO, ALLA
Entity type:Individual
Prefix:
First Name:ALLA
Middle Name:
Last Name:MEYKO
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 1:1085 HARTFORD TPKE APT 433
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-4492
Mailing Address - Country:US
Mailing Address - Phone:413-426-7316
Mailing Address - Fax:
Practice Address - Street 1:1085 HARTFORD TPKE APT 433
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066-4492
Practice Address - Country:US
Practice Address - Phone:413-426-7316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-22
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN85351164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse