Individual
IVEREN MYADZE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
7300 CHARLESWORTH DR, HUBER HEIGHTS, OH 45424-3256
(937) 607-8845
Mailing address
PO BOX 24423, HUBER HEIGHTS, OH 45424-0423
(937) 607-8845
Taxonomy
Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
Primary
—
—
376J00000X
Homemaker
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2414686
—
OH
Enumeration date
11/21/2020
Last updated
11/21/2020
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