Provider Demographics
NPI:1720601537
Name:TIMOFEYEVA, LYUDMILA (RN)
Entity Type:Individual
Prefix:
First Name:LYUDMILA
Middle Name:
Last Name:TIMOFEYEVA
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 1:11215 72ND RD STE LL1
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-4600
Mailing Address - Country:US
Mailing Address - Phone:718-261-3437
Mailing Address - Fax:718-261-4142
Practice Address - Street 1:11215 72ND RD STE LL1
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4600
Practice Address - Country:US
Practice Address - Phone:718-261-3437
Practice Address - Fax:718-261-4142
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-27
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY649246-01163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse