Provider Demographics
NPI:1598123044
Name:YUSUPOVA, ANZHELA (RN)
Entity Type:Individual
Prefix:MISS
First Name:ANZHELA
Middle Name:
Last Name:YUSUPOVA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4520 12TH AVE APT E4
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-2013
Mailing Address - Country:US
Mailing Address - Phone:347-858-4808
Mailing Address - Fax:
Practice Address - Street 1:4520 12TH AVE APT E4
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-2013
Practice Address - Country:US
Practice Address - Phone:347-858-4808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-28
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY678337-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse