Provider Demographics
NPI:1215009568
Name:PONOMARENKO, ALEX (ARNP)
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:PONOMARENKO
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 W INDIANA AVE STE B
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-4763
Mailing Address - Country:US
Mailing Address - Phone:509-326-6474
Mailing Address - Fax:
Practice Address - Street 1:205 W INDIANA AVE STE B
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-4763
Practice Address - Country:US
Practice Address - Phone:509-326-6474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30007005363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care