Provider Demographics
NPI:1730720129
Name:VANZHULA, IRINA ALEXANDROVNA (MS)
Entity type:Individual
Prefix:
First Name:IRINA
Middle Name:ALEXANDROVNA
Last Name:VANZHULA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11824 RANSUM DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40243-2802
Mailing Address - Country:US
Mailing Address - Phone:563-209-0904
Mailing Address - Fax:
Practice Address - Street 1:11824 RANSUM DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40243-2802
Practice Address - Country:US
Practice Address - Phone:563-209-0904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-07
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program