Provider Demographics
NPI:1851953855
Name:KOLESNIKOVA, SOFIA YURJEVNA (ARNP)
Entity Type:Individual
Prefix:
First Name:SOFIA
Middle Name:YURJEVNA
Last Name:KOLESNIKOVA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2930 S MERIDIAN
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-1654
Mailing Address - Country:US
Mailing Address - Phone:253-445-7600
Mailing Address - Fax:253-426-6344
Practice Address - Street 1:2930 S MERIDIAN
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-1654
Practice Address - Country:US
Practice Address - Phone:253-445-7600
Practice Address - Fax:253-426-6344
Is Sole Proprietor?:No
Enumeration Date:2019-07-01
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60978144363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2138222Medicaid