Provider Demographics
NPI:1588843791
Name:IANAKIEV, BORIANA EMIL (CNM, ARNP)
Entity Type:Individual
Prefix:MS
First Name:BORIANA
Middle Name:EMIL
Last Name:IANAKIEV
Suffix:
Gender:F
Credentials:CNM, ARNP
Other - Prefix:MRS
Other - First Name:BORIANA
Other - Middle Name:
Other - Last Name:BOTCHEV
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1608 S J ST
Mailing Address - Street 2:FLOOR 2
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4930
Mailing Address - Country:US
Mailing Address - Phone:253-274-7501
Mailing Address - Fax:253-274-7991
Practice Address - Street 1:1608 S J ST
Practice Address - Street 2:FLOOR 2
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4930
Practice Address - Country:US
Practice Address - Phone:253-274-7501
Practice Address - Fax:253-274-7991
Is Sole Proprietor?:No
Enumeration Date:2007-10-24
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30007798363L00000X
367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8926315Medicare PIN