Provider Demographics
NPI:1891004958
Name:KORNIYCHUK, YULYA (LMP)
Entity Type:Individual
Prefix:MRS
First Name:YULYA
Middle Name:
Last Name:KORNIYCHUK
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18308 101ST ST E
Mailing Address - Street 2:
Mailing Address - City:BONNEY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98391-8154
Mailing Address - Country:US
Mailing Address - Phone:253-347-5531
Mailing Address - Fax:
Practice Address - Street 1:18308 101ST ST E
Practice Address - Street 2:
Practice Address - City:BONNEY LAKE
Practice Address - State:WA
Practice Address - Zip Code:98391-8154
Practice Address - Country:US
Practice Address - Phone:253-347-5531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-06
Last Update Date:2010-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60172757173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine