Provider Demographics
NPI:1154322097
Name:DYMARSKIY, YANA (APRN, FNP)
Entity Type:Individual
Prefix:
First Name:YANA
Middle Name:
Last Name:DYMARSKIY
Suffix:
Gender:F
Credentials:APRN, FNP
Other - Prefix:
Other - First Name:YANA
Other - Middle Name:
Other - Last Name:KONOVALOV
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN, FNP
Mailing Address - Street 1:6829 N LAKEWOOD AVE
Mailing Address - Street 2:APT 3
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626-3876
Mailing Address - Country:US
Mailing Address - Phone:773-262-1581
Mailing Address - Fax:312-266-8797
Practice Address - Street 1:1200 N LASALLE ST
Practice Address - Street 2:PLANNED PARENTHOOD
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-1913
Practice Address - Country:US
Practice Address - Phone:312-266-1033
Practice Address - Fax:312-266-8997
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL201038OtherHCFA
IL201038OtherHCFA