Provider Demographics
NPI:1639996473
Name:KHAIMOVA, EVELINA (RN-IBCLC)
Entity type:Individual
Prefix:
First Name:EVELINA
Middle Name:
Last Name:KHAIMOVA
Suffix:
Gender:F
Credentials:RN-IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7337 141ST PL
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-2834
Mailing Address - Country:US
Mailing Address - Phone:347-404-0355
Mailing Address - Fax:
Practice Address - Street 1:7337 141ST PL
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-2834
Practice Address - Country:US
Practice Address - Phone:347-404-0355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY691055163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty