Provider Demographics
NPI:1902793748
Name:REVENKOV, NATALYA
Entity type:Individual
Prefix:
First Name:NATALYA
Middle Name:
Last Name:REVENKOV
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 1:15328 DAVENPORT CIR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-2044
Mailing Address - Country:US
Mailing Address - Phone:402-880-2490
Mailing Address - Fax:
Practice Address - Street 1:6916 N 102ND CIR
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68122-3056
Practice Address - Country:US
Practice Address - Phone:402-504-8916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-23
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide