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ALEXANDRE DEREVIANKO NPI 1679987879


NPI Information

NPI: 1679987879
Provider Name: ALEXANDRE DEREVIANKO
Classification: Specialist/Technologist, Other - 246ZC0007X
Entity Type: Individual

Specialization: Surgical Assistant

Address:
1811 ARKANSAS AVE
GREAT LAKES, IL
ZIP 60088
Phone: (401) 480-9807
Get Directions

Alexandre Derevianko is a surgical assistant specialist technologist other in Great Lakes, IL. The provider is a surgical assistant is a skilled practitioner who has undergone formalized education and training as a surgical assistant. The surgical assistant performs surgical functions that include, but are not limited to: retracting, manipulating, suturing, clamping, cauterizing, litigating, and tying tissue; suctioning, irrigating and sponging; positioning the patient; closure of body planes and skin; and participating in hemostasis and volume replacement. Surgical assistants are certified and registered or licensed by the state, or, in states without licensure, certified as surgical assistants by completing appropriate education and training. Alexandre Derevianko NPI is 1679987879. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

1811 ARKANSAS AVE
GREAT LAKES, IL
ZIP 60088-244
Phone: (401) 480-9807
Fax: (847) 733-5827

The enumeration date for this NPI number is 6/16/2014 and was last updated on 6/19/2014.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1246ZC0007XSpecialist/Technologist, OtherSurgical Assistant238000408ILLINOISYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1238000408OTHERILLINOISLICENSE NUMBER

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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