Provider Demographics
NPI:1629210547
Name:KHOMCHENKO, NATALLIA (RN)
Entity Type:Individual
Prefix:
First Name:NATALLIA
Middle Name:
Last Name:KHOMCHENKO
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 1:2873 CROPSEY AVE APT 3F
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-7246
Mailing Address - Country:US
Mailing Address - Phone:347-385-7883
Mailing Address - Fax:
Practice Address - Street 1:2873 CROPSEY AVE APT 3F
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-7246
Practice Address - Country:US
Practice Address - Phone:347-385-7883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-25
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY612017163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health