Provider Demographics
NPI:1093271413
Name:BOGUSLAVSKY, YELENA Y (NP)
Entity Type:Individual
Prefix:MRS
First Name:YELENA
Middle Name:Y
Last Name:BOGUSLAVSKY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 W CLAY ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23220-3114
Mailing Address - Country:US
Mailing Address - Phone:540-371-0079
Mailing Address - Fax:
Practice Address - Street 1:2841 RIVER RD W
Practice Address - Street 2:
Practice Address - City:GOOCHLAND
Practice Address - State:VA
Practice Address - Zip Code:23063-3200
Practice Address - Country:US
Practice Address - Phone:804-556-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-11
Last Update Date:2021-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024176950363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology