Provider Demographics
NPI:1750895116
Name:YAKOVLEVA, MARTA B (RN,)
Entity type:Individual
Prefix:
First Name:MARTA
Middle Name:B
Last Name:YAKOVLEVA
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 1:3605 104TH AVE N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55443-1015
Mailing Address - Country:US
Mailing Address - Phone:612-723-6682
Mailing Address - Fax:
Practice Address - Street 1:3605 104TH AVE N
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55443-1015
Practice Address - Country:US
Practice Address - Phone:612-723-6682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-21
Last Update Date:2017-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR2297413163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse