Provider Demographics
NPI:1457643611
Name:VERNAYA, MARINA LAZAREVNA (MSN, FNP-C)
Entity Type:Individual
Prefix:MS
First Name:MARINA
Middle Name:LAZAREVNA
Last Name:VERNAYA
Suffix:
Gender:F
Credentials:MSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7855 SANTA MONICA BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90046-5344
Mailing Address - Country:US
Mailing Address - Phone:310-623-9222
Mailing Address - Fax:310-921-5623
Practice Address - Street 1:7855 SANTA MONICA BLVD
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90046-5344
Practice Address - Country:US
Practice Address - Phone:310-623-9222
Practice Address - Fax:310-921-5623
Is Sole Proprietor?:No
Enumeration Date:2011-05-06
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19690363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily