Provider Demographics
NPI:1831963552
Name:SHUMKOV, ALESYA (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:ALESYA
Middle Name:
Last Name:SHUMKOV
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 PLYMOUTH RD STE D
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-1969
Mailing Address - Country:US
Mailing Address - Phone:612-388-1902
Mailing Address - Fax:
Practice Address - Street 1:1700 PLYMOUTH RD STE D
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-1969
Practice Address - Country:US
Practice Address - Phone:612-963-2784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11015363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty