Provider Demographics
NPI:1467674275
Name:KORNEEVA, NATALIA (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:NATALIA
Middle Name:
Last Name:KORNEEVA
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3976 UNIVERSITY LAKE DR STE 300
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4644
Mailing Address - Country:US
Mailing Address - Phone:907-222-9930
Mailing Address - Fax:907-222-9931
Practice Address - Street 1:3976 UNIVERSITY LAKE DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4644
Practice Address - Country:US
Practice Address - Phone:907-222-9930
Practice Address - Fax:503-734-3808
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301088654207V00000X
ORMD150768207V00000X
AK129052207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500623008Medicaid
ORR172907OtherMEDICARE PTAN