Provider Demographics
NPI:1265710776
Name:FRUNCHAK, YELENA (MS, FNP)
Entity type:Individual
Prefix:
First Name:YELENA
Middle Name:
Last Name:FRUNCHAK
Suffix:
Gender:F
Credentials:MS, FNP
Other - Prefix:
Other - First Name:YELENA
Other - Middle Name:
Other - Last Name:RUDYI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, FNP
Mailing Address - Street 1:2640 S EAGLE RD
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-6704
Mailing Address - Country:US
Mailing Address - Phone:208-884-0835
Mailing Address - Fax:208-884-4794
Practice Address - Street 1:2640 S EAGLE RD
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-6704
Practice Address - Country:US
Practice Address - Phone:208-884-0835
Practice Address - Fax:208-884-4794
Is Sole Proprietor?:No
Enumeration Date:2011-08-01
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP-1076A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily