Basic Information
| Provider Information | |||||||||
| NPI: | 1639459126 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRINBLAT | ||||||||
| FirstName: | IRINA | ||||||||
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| Credential: | NP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6780 MAYFIELD RD | ||||||||
| Address2: | STE 323 | ||||||||
| City: | MAYFIELD HEIGHTS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441242203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4403127140 | ||||||||
| FaxNumber: | 4403127142 | ||||||||
| Practice Location | |||||||||
| Address1: | 24755 CHAGRIN BLVD | ||||||||
| Address2: | |||||||||
| City: | BEACHWOOD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441225682 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2164640778 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2011 | ||||||||
| LastUpdateDate: | 03/02/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | COA.12562-NP | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.