Doctor Name: | JULIA KVIATKOVSKAYA |
NPI Number: | 1013272772 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | CPNP-AC |
License Number: | AP123374 |
Business Practice Address: | 101 Potasio St Fabens, TX - 79838 |
Business Phone Number: | 4048675817 |
Business Fax Number: | |
Mailing Address: | 101 Potasio St, FABENS |
State: | TX |
Postal Code: | 79838 |
Phone Number: | 4048675817 |
Fax Number: | |
NPI Enumeration Date: | 07/09/2012 |
NPI Last Update Date: | 02/26/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LP0200X |
License Number: | AP123374 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Pediatrics |
Taxonomy Definition: |