Provider Demographics
NPI:1730885955
Name:UMIN, MIKAYLA
Entity type:Individual
Prefix:
First Name:MIKAYLA
Middle Name:
Last Name:UMIN
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 1:1856 MATTINGLY RD
Mailing Address - Street 2:
Mailing Address - City:HINCKLEY
Mailing Address - State:OH
Mailing Address - Zip Code:44233-9426
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1856 MATTINGLY RD
Practice Address - Street 2:
Practice Address - City:HINCKLEY
Practice Address - State:OH
Practice Address - Zip Code:44233-9426
Practice Address - Country:US
Practice Address - Phone:330-391-8845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-31
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251K00000X, 251X00000X, 347C00000X
OH3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
No251K00000XAgenciesPublic Health or Welfare
No251X00000XAgenciesSupports Brokerage
No347C00000XTransportation ServicesPrivate Vehicle