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Individual

TATIANA MYNUK

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
1108 WASHINGTON ST E, LEWISBURG, WV 24901-2523
(304) 645-2130
Mailing address
1108 WASHINGTON ST E, LEWISBURG, WV 24901-2523
(304) 645-2130

Taxonomy

Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
550701927
WV
Enumeration date
12/31/2020
Last updated
12/31/2020
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