Provider Demographics
NPI:1942803358
Name:SEMENOVA, ANASTASIA VLADIMIROVNA (PA)
Entity Type:Individual
Prefix:
First Name:ANASTASIA
Middle Name:VLADIMIROVNA
Last Name:SEMENOVA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 N L ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98403-1726
Mailing Address - Country:US
Mailing Address - Phone:703-855-7396
Mailing Address - Fax:
Practice Address - Street 1:800 S DUKE ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27701-3902
Practice Address - Country:US
Practice Address - Phone:919-801-3573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA61102516363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant