Provider Demographics
NPI:1073918181
Name:KRICHBAUM, EMILIYA (RN)
Entity type:Individual
Prefix:
First Name:EMILIYA
Middle Name:
Last Name:KRICHBAUM
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:EMILIYA
Other - Middle Name:
Other - Last Name:SHCHEHLYUK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:600 VINEYARD DR APT 202
Mailing Address - Street 2:
Mailing Address - City:BROADVIEW HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44147-3344
Mailing Address - Country:US
Mailing Address - Phone:567-203-3502
Mailing Address - Fax:
Practice Address - Street 1:600 VINEYARD DR APT 202
Practice Address - Street 2:
Practice Address - City:BROADVIEW HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44147-3344
Practice Address - Country:US
Practice Address - Phone:567-203-3502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-31
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN 366421163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse