Provider Demographics
NPI:1346423704
Name:KOLESNIKOVA, VIOLETTA ALEKSEEVNA (MD)
Entity Type:Individual
Prefix:DR
First Name:VIOLETTA
Middle Name:ALEKSEEVNA
Last Name:KOLESNIKOVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:VIOLETTA
Other - Middle Name:ALEKSEEVNA
Other - Last Name:CHERNYSHCHUK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:700 NE 87TH AVE
Mailing Address - Street 2:SUITE 350
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98664-1913
Mailing Address - Country:US
Mailing Address - Phone:360-882-2778
Mailing Address - Fax:360-604-1724
Practice Address - Street 1:700 NE 87TH AVE
Practice Address - Street 2:SUITE 350
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-1913
Practice Address - Country:US
Practice Address - Phone:360-882-2778
Practice Address - Fax:360-604-1724
Is Sole Proprietor?:No
Enumeration Date:2007-12-07
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD125614207ZP0102X
WAMD60117916207ZP0102X, 207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8908874Medicare PIN