Provider Demographics
NPI:1710110119
Name:ARTEMENKO, SERGEY VASILY SR (PHD,ND)
Entity Type:Individual
Prefix:DR
First Name:SERGEY
Middle Name:VASILY
Last Name:ARTEMENKO
Suffix:SR
Gender:M
Credentials:PHD,ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 298323
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99629-8323
Mailing Address - Country:US
Mailing Address - Phone:907-232-6046
Mailing Address - Fax:
Practice Address - Street 1:8701 RUNAMUCK PL
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99502-5630
Practice Address - Country:US
Practice Address - Phone:907-232-6046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-01
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK933371251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health