Provider Demographics
NPI:1689364671
Name:POTYOMKIN, LYUDMILA (ARNP)
Entity Type:Individual
Prefix:
First Name:LYUDMILA
Middle Name:
Last Name:POTYOMKIN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8793 233RD PL NE
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98053-1974
Mailing Address - Country:US
Mailing Address - Phone:206-290-7889
Mailing Address - Fax:
Practice Address - Street 1:8793 233RD PL NE
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98053-1974
Practice Address - Country:US
Practice Address - Phone:206-290-7889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-11
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61442635363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty