Provider Demographics
NPI:1760779821
Name:ALTUKHOV, VERA G (L M T)
Entity Type:Individual
Prefix:
First Name:VERA
Middle Name:G
Last Name:ALTUKHOV
Suffix:
Gender:F
Credentials:L M T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5625 N WALL ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-6435
Mailing Address - Country:US
Mailing Address - Phone:509-482-1982
Mailing Address - Fax:509-482-1983
Practice Address - Street 1:5625 N WALL ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-6435
Practice Address - Country:US
Practice Address - Phone:509-482-1982
Practice Address - Fax:509-482-1983
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-08
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60161808174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist