Provider Demographics
NPI:1225336910
Name:MARCHENKO, ANDREI (CNP)
Entity Type:Individual
Prefix:
First Name:ANDREI
Middle Name:
Last Name:MARCHENKO
Suffix:
Gender:M
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10401 MONTGOMERY PKWY NE STE 150
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-3876
Mailing Address - Country:US
Mailing Address - Phone:505-234-1040
Mailing Address - Fax:505-407-8150
Practice Address - Street 1:10401 MONTGOMERY PKWY NE STE 150
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-3876
Practice Address - Country:US
Practice Address - Phone:505-234-1040
Practice Address - Fax:505-407-8150
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-04
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP01745363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner