Provider Demographics
NPI:1194469155
Name:ZOLOTNIKOVA, LARISA
Entity Type:Individual
Prefix:
First Name:LARISA
Middle Name:
Last Name:ZOLOTNIKOVA
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 1:2533 BATCHELDER ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-1414
Mailing Address - Country:US
Mailing Address - Phone:718-915-4332
Mailing Address - Fax:
Practice Address - Street 1:2533 BATCHELDER ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-1414
Practice Address - Country:US
Practice Address - Phone:718-915-4332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-26
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY816089163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse