Provider Demographics
NPI:1144919754
Name:YEPIFANOVA, YEKATERINA M
Entity type:Individual
Prefix:
First Name:YEKATERINA
Middle Name:M
Last Name:YEPIFANOVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1789 MOUNTAINSIDE DR
Mailing Address - Street 2:
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-9201
Mailing Address - Country:US
Mailing Address - Phone:540-314-6492
Mailing Address - Fax:
Practice Address - Street 1:2901 LAMB CIR
Practice Address - Street 2:
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-6347
Practice Address - Country:US
Practice Address - Phone:540-639-5888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-01
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024187246363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner