Provider Demographics
NPI:1952066060
Name:USTYNOVA, TETYANA (RN)
Entity Type:Individual
Prefix:
First Name:TETYANA
Middle Name:
Last Name:USTYNOVA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3807 SIERRA HWY STE 207
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:CA
Mailing Address - Zip Code:93510-1256
Mailing Address - Country:US
Mailing Address - Phone:661-269-2279
Mailing Address - Fax:661-269-2026
Practice Address - Street 1:3807 SIERRA HWY STE 207
Practice Address - Street 2:
Practice Address - City:ACTON
Practice Address - State:CA
Practice Address - Zip Code:93510-1256
Practice Address - Country:US
Practice Address - Phone:661-269-2279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-03
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA801867163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse