Provider Demographics
NPI:1407121114
Name:MANYOKY, YEKATERINA LEONIDOVNA (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:YEKATERINA
Middle Name:LEONIDOVNA
Last Name:MANYOKY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:YEKATERINA
Other - Middle Name:LEONIDOVNA
Other - Last Name:LUTONIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4320 DIPLOMACY DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5925
Mailing Address - Country:US
Mailing Address - Phone:907-729-3300
Mailing Address - Fax:907-729-3363
Practice Address - Street 1:4320 DIPLOMACY DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5925
Practice Address - Country:US
Practice Address - Phone:907-729-3300
Practice Address - Fax:907-729-3363
Is Sole Proprietor?:No
Enumeration Date:2012-03-13
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2181363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant