Provider Demographics
NPI:1629859459
Name:IVANKIV, LESYA (FNP)
Entity Type:Individual
Prefix:
First Name:LESYA
Middle Name:
Last Name:IVANKIV
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2758 OCEAN AVE APT 1C
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-4753
Mailing Address - Country:US
Mailing Address - Phone:646-545-0006
Mailing Address - Fax:
Practice Address - Street 1:2758 OCEAN AVE APT 1C
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-4753
Practice Address - Country:US
Practice Address - Phone:646-545-0006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY352887363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily