Provider Demographics
NPI:1376901629
Name:LIBKHEN, YEVGENIYA (LDN)
Entity Type:Individual
Prefix:
First Name:YEVGENIYA
Middle Name:
Last Name:LIBKHEN
Suffix:
Gender:F
Credentials:LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5937 AUTUMN SPELL
Mailing Address - Street 2:
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-5962
Mailing Address - Country:US
Mailing Address - Phone:323-684-4226
Mailing Address - Fax:
Practice Address - Street 1:5937 AUTUMN SPELL
Practice Address - Street 2:
Practice Address - City:ELKRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21075-5962
Practice Address - Country:US
Practice Address - Phone:323-684-4226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-02
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX3754133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist