Provider Demographics
NPI:1699222513
Name:MARCHENKO, LYUDMYLA
Entity Type:Individual
Prefix:MRS
First Name:LYUDMYLA
Middle Name:
Last Name:MARCHENKO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LYUDMYLA
Other - Middle Name:
Other - Last Name:MARCHENKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12632 WOODYGROVE CT
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-4547
Mailing Address - Country:US
Mailing Address - Phone:314-304-0404
Mailing Address - Fax:
Practice Address - Street 1:12632 WOODYGROVE CT
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63146-4547
Practice Address - Country:US
Practice Address - Phone:314-304-0404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-08
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program