Provider Demographics
NPI:1790346443
Name:KLIMOVA, ELENA NICKOLAEVNA (NP)
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:NICKOLAEVNA
Last Name:KLIMOVA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ELENA
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2218 E WAHALLA LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85024-1231
Mailing Address - Country:US
Mailing Address - Phone:480-773-9035
Mailing Address - Fax:
Practice Address - Street 1:2218 E WAHALLA LN
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85024-1231
Practice Address - Country:US
Practice Address - Phone:480-773-9035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-24
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ226877363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care