Provider Demographics
NPI:1134874027
Name:KUZNETSOV, NATALY (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:NATALY
Middle Name:
Last Name:KUZNETSOV
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 FRANKLIN ST STE 8
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94559-2949
Mailing Address - Country:US
Mailing Address - Phone:530-625-7738
Mailing Address - Fax:530-862-4238
Practice Address - Street 1:833 FRANKLIN ST STE 8
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94559-2949
Practice Address - Country:US
Practice Address - Phone:530-625-7738
Practice Address - Fax:530-862-4238
Is Sole Proprietor?:No
Enumeration Date:2022-02-18
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95020035363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health