Provider Demographics
NPI:1043077498
Name:YURCHAK / KUUSK, ANNA VADIMIVNA (APN)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:VADIMIVNA
Last Name:YURCHAK / KUUSK
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:786 FOXMOOR DR
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08361-7254
Mailing Address - Country:US
Mailing Address - Phone:609-805-1132
Mailing Address - Fax:
Practice Address - Street 1:786 FOXMOOR DR
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08361-7254
Practice Address - Country:US
Practice Address - Phone:609-805-1132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR18249300163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice