Provider Demographics
NPI:1104576339
Name:NEKRASA, DMYTRO
Entity type:Individual
Prefix:
First Name:DMYTRO
Middle Name:
Last Name:NEKRASA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 MADELINE CIR
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-4016
Mailing Address - Country:US
Mailing Address - Phone:304-777-0965
Mailing Address - Fax:
Practice Address - Street 1:27 MADELINE CIR
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26508-4016
Practice Address - Country:US
Practice Address - Phone:304-777-0965
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-29
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant