Provider Demographics
NPI:1124163829
Name:KOVACHI, JOAN M (RN)
Entity type:Individual
Prefix:MS
First Name:JOAN
Middle Name:M
Last Name:KOVACHI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2106 KENYON RD
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:NY
Mailing Address - Zip Code:14519
Mailing Address - Country:US
Mailing Address - Phone:315-524-3654
Mailing Address - Fax:
Practice Address - Street 1:WAYNE BEHAVIORAL HEALTH NETWORK
Practice Address - Street 2:1519 NYE ROAD
Practice Address - City:LYONS
Practice Address - State:NY
Practice Address - Zip Code:14489
Practice Address - Country:US
Practice Address - Phone:315-946-5722
Practice Address - Fax:315-946-7066
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1378901163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse