Provider Demographics
NPI:1801029301
Name:YERMAKOV, NATALIA (ARNP)
Entity Type:Individual
Prefix:
First Name:NATALIA
Middle Name:
Last Name:YERMAKOV
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:NATALIA
Other - Middle Name:
Other - Last Name:BARKO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ARNP
Mailing Address - Street 1:8524 W GAGE BLVD
Mailing Address - Street 2:BLDG A1 BOX 319
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-8241
Mailing Address - Country:US
Mailing Address - Phone:509-591-0070
Mailing Address - Fax:509-396-9661
Practice Address - Street 1:12709 E MIRABEAU PKWY
Practice Address - Street 2:BLDG A STE 200
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216
Practice Address - Country:US
Practice Address - Phone:509-591-0070
Practice Address - Fax:509-396-9661
Is Sole Proprietor?:No
Enumeration Date:2009-08-31
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60105169363LP2300X, 363LF0000X
WAAP60105136363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2003606Medicaid