Provider Demographics
NPI:1396412334
Name:KHOROSHEVA-BROWN, ELENA V (LPN, GEM-STONE THERA)
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:V
Last Name:KHOROSHEVA-BROWN
Suffix:
Gender:F
Credentials:LPN, GEM-STONE THERA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 ROLLINGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:KELSO
Mailing Address - State:WA
Mailing Address - Zip Code:98626-9756
Mailing Address - Country:US
Mailing Address - Phone:503-442-8826
Mailing Address - Fax:
Practice Address - Street 1:330 ROLLINGWOOD DR
Practice Address - Street 2:
Practice Address - City:KELSO
Practice Address - State:WA
Practice Address - Zip Code:98626-9756
Practice Address - Country:US
Practice Address - Phone:503-442-8826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-26
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP60440752164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty