Provider Demographics
NPI:1891245445
Name:KOVALENKO, KARINA
Entity Type:Individual
Prefix:
First Name:KARINA
Middle Name:
Last Name:KOVALENKO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8804 ALICE AVE
Mailing Address - Street 2:
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-5474
Mailing Address - Country:US
Mailing Address - Phone:515-306-6373
Mailing Address - Fax:844-586-5123
Practice Address - Street 1:8804 ALICE AVE
Practice Address - Street 2:
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-5474
Practice Address - Country:US
Practice Address - Phone:515-306-6373
Practice Address - Fax:844-586-5123
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-06
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)