Provider Demographics
NPI:1063641405
Name:MOSKALENKO, NATALYA (LMP)
Entity Type:Individual
Prefix:
First Name:NATALYA
Middle Name:
Last Name:MOSKALENKO
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:NATALYA
Other - Middle Name:TIMOFEYEVNA
Other - Last Name:TUCKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMP
Mailing Address - Street 1:17651 1ST AVE S
Mailing Address - Street 2:STE 101
Mailing Address - City:NORMANDY PARK
Mailing Address - State:WA
Mailing Address - Zip Code:98148-2715
Mailing Address - Country:US
Mailing Address - Phone:206-241-3836
Mailing Address - Fax:206-241-3967
Practice Address - Street 1:17651 1ST AVE S
Practice Address - Street 2:STE 101
Practice Address - City:NORMANDY PARK
Practice Address - State:WA
Practice Address - Zip Code:98148-2715
Practice Address - Country:US
Practice Address - Phone:206-241-3836
Practice Address - Fax:206-241-3967
Is Sole Proprietor?:No
Enumeration Date:2009-07-07
Last Update Date:2009-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60085502225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist