Doctor Name: | ALENA F PONKRATOV |
NPI Number: | 1164785531 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | ARNP |
License Number: | AP60267251 |
Business Practice Address: | 2690 Ne Kresky Ave Chehalis, WA - 985322412 |
Business Phone Number: | 3603309595 |
Business Fax Number: | |
Mailing Address: | 2690 Ne Kresky Ave, CHEHALIS |
State: | WA |
Postal Code: | 985322412 |
Phone Number: | 3603309595 |
Fax Number: | |
NPI Enumeration Date: | 06/20/2012 |
NPI Last Update Date: | 10/01/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | AP60267251 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |