Provider Demographics
NPI:1508183468
Name:GOLOVANOV, NATALYA (NP-C, ND)
Entity Type:Individual
Prefix:DR
First Name:NATALYA
Middle Name:
Last Name:GOLOVANOV
Suffix:
Gender:F
Credentials:NP-C, ND
Other - Prefix:MS
Other - First Name:NATALYA
Other - Middle Name:
Other - Last Name:GOLOVANOV
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NURSE PRACTITIONER
Mailing Address - Street 1:43 QUAIL CT OFC PARK102
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-8701
Mailing Address - Country:US
Mailing Address - Phone:415-948-8999
Mailing Address - Fax:925-695-0406
Practice Address - Street 1:43 QUAIL CT OFC PARK102
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-8701
Practice Address - Country:US
Practice Address - Phone:925-695-3113
Practice Address - Fax:925-695-0406
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-30
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND-124175F00000X
CA95003717363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95003717OtherNURSE PRACTITIONER