Provider Demographics
NPI:1902654460
Name:KORKOVETSKA, IRYNA (MS, RDN)
Entity Type:Individual
Prefix:
First Name:IRYNA
Middle Name:
Last Name:KORKOVETSKA
Suffix:
Gender:F
Credentials:MS, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7525 W LAWRENCE AVE UNIT 508
Mailing Address - Street 2:
Mailing Address - City:HARWOOD HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60706-3497
Mailing Address - Country:US
Mailing Address - Phone:872-210-7819
Mailing Address - Fax:872-210-7819
Practice Address - Street 1:7525 W LAWRENCE AVE UNIT 508
Practice Address - Street 2:
Practice Address - City:HARWOOD HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60706-3497
Practice Address - Country:US
Practice Address - Phone:872-210-7819
Practice Address - Fax:872-210-7819
Is Sole Proprietor?:No
Enumeration Date:2024-05-09
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL86343644133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered