Provider Demographics
NPI:1588974190
Name:IYERE, PAULINA ISI
Entity type:Individual
Prefix:MRS
First Name:PAULINA
Middle Name:ISI
Last Name:IYERE
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 1:1357 THACKER CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43204-2148
Mailing Address - Country:US
Mailing Address - Phone:614-615-7894
Mailing Address - Fax:
Practice Address - Street 1:1357 THACKER CT
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43204-2148
Practice Address - Country:US
Practice Address - Phone:614-615-7894
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-15
Last Update Date:2024-08-07
Deactivation Date:2024-05-24
Deactivation Code:
Reactivation Date:2024-06-10
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH259526401601Medicaid