Provider Demographics
NPI:1609460963
Name:DVERINA, NATALYA (RN MSN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:NATALYA
Middle Name:
Last Name:DVERINA
Suffix:
Gender:F
Credentials:RN MSN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4901 BILOXI AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91601-4814
Mailing Address - Country:US
Mailing Address - Phone:310-962-6991
Mailing Address - Fax:
Practice Address - Street 1:5901 W OLYMPIC BLVD STE 309
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-4664
Practice Address - Country:US
Practice Address - Phone:310-623-1911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-25
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95016793363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily