Provider Demographics
NPI:1629820931
Name:VINOGRADOVA, VERA (RN)
Entity Type:Individual
Prefix:
First Name:VERA
Middle Name:
Last Name:VINOGRADOVA
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 1:2690 FORD ST FL 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-1307
Mailing Address - Country:US
Mailing Address - Phone:347-575-4649
Mailing Address - Fax:
Practice Address - Street 1:2690 FORD ST FL 2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-1307
Practice Address - Country:US
Practice Address - Phone:347-575-4649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-02
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY707558163WE0003X, 163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WE0003XNursing Service ProvidersRegistered NurseEmergencyGroup - Multi-Specialty