Provider Demographics
NPI:1770128589
Name:MCKLUSKY, IRENE E
Entity type:Individual
Prefix:
First Name:IRENE
Middle Name:E
Last Name:MCKLUSKY
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 1:124 E CATAWBA AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44301
Mailing Address - Country:US
Mailing Address - Phone:330-861-4377
Mailing Address - Fax:
Practice Address - Street 1:124 E CATAWBA AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44301
Practice Address - Country:US
Practice Address - Phone:330-861-4377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-15
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider