Active NPI
Irena Bovkun, RD, LD, CNSC
- Registered Dietitian
- Garfield Heights, OH
National Provider Identifier
1780103945
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- LD.08314
- Practice address
- 12300 McCracken Rd
Garfield Heights, OH 44125-2914 - Phone
- (216) 587-8998
- NPI assigned
- Sep 19, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | |||
| Registered Dietitian | 133V00000X | LD.08314 | OH | Primary |
Addresses
Primary practice location
12300 McCracken Rd
Garfield Heights, OH 44125-2914
Mailing address
12300 McCracken Rd
Garfield Heights, OH 44125-2914
Phone (607) 423-9616
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LD.08314 | OH | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1505779200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1665446400000",
"number": "1780103945",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12300 MCCRACKEN RD",
"city": "GARFIELD HEIGHTS",
"state": "OH",
"postal_code": "441252914",
"telephone_number": "607-423-9616"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12300 MCCRACKEN RD",
"city": "GARFIELD HEIGHTS",
"state": "OH",
"postal_code": "441252914",
"telephone_number": "216-587-8998"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOVKUN",
"first_name": "IRENA",
"credential": "RD, LD, CNSC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-09-19",
"last_updated": "2022-10-11",
"certification_date": "2022-10-11",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": null,
"license": null,
"primary": false
},
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "OH",
"license": "LD.08314",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Garfield Heights, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.