Provider Demographics
NPI:1316395171
Name:IVANOVA, NATALIA
Entity Type:Individual
Prefix:
First Name:NATALIA
Middle Name:
Last Name:IVANOVA
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 1:2258 OCEAN AVE
Mailing Address - Street 2:APT D9
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-2252
Mailing Address - Country:US
Mailing Address - Phone:347-241-9325
Mailing Address - Fax:
Practice Address - Street 1:2258 OCEAN AVE
Practice Address - Street 2:APT D9
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-2252
Practice Address - Country:US
Practice Address - Phone:347-241-9325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-01
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY715501163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse