Provider Demographics
NPI:1063563534
Name:KROYNOVICH, MARY K
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:K
Last Name:KROYNOVICH
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 1:6805 MAYFIELD RD APT 1021
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-6021
Mailing Address - Country:US
Mailing Address - Phone:216-355-8431
Mailing Address - Fax:
Practice Address - Street 1:6805 MAYFIELD RD APT 1021
Practice Address - Street 2:
Practice Address - City:MAYFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44124-6021
Practice Address - Country:US
Practice Address - Phone:216-355-8431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2564667Medicaid