Provider Demographics
NPI:1306356977
Name:KERPAN, NATALIYA I
Entity Type:Individual
Prefix:MRS
First Name:NATALIYA
Middle Name:I
Last Name:KERPAN
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 1:2321 114TH ST SW
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98204-4787
Mailing Address - Country:US
Mailing Address - Phone:425-343-8316
Mailing Address - Fax:425-512-9240
Practice Address - Street 1:2803 GRAND AVE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-3417
Practice Address - Country:US
Practice Address - Phone:425-512-9240
Practice Address - Fax:425-512-9240
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-09
Last Update Date:2017-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60769929225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist