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Individual

PHIL JAMES NYDEREK SR.

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
103 ASHMOORE DRIVE, GREENUP, KY 41144
(740) 821-6973
(606) 473-1389
Mailing address
103 ASHMOORE DRIVE, GREENUP, KY 41144
(740) 821-6973
(606) 473-1389

Taxonomy

Speciality
Code
Description
License number
State
171WH0202X
Home Modifications Contractor
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
2778632
OH
Enumeration date
06/03/2008
Last updated
05/12/2015
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