Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0401X | Family Doctor - Addiction Medicine | 34.010590 | OH |
N | 207QA0401X | Family Doctor - Addiction Medicine | 9495192-1204 | UT |
N | 207QA0401X | Family Doctor - Addiction Medicine | 9521A | WY |
N | 207QA0401X | Family Doctor - Addiction Medicine | OC-0034 | ID |
Y | 207QA0401X | Family Doctor - Addiction Medicine | OP60945031 | WA |
N | 207QA0401X | Family Doctor - Addiction Medicine | OS015088 | PA |
N | 208D00000X | General Practice Physician | 48154 | CO |
NPI | 1710110820 |
---|---|
Provider Name | Elina Chernyak |
First Address | Clarkston, WA 99403-0189 |
Second Address | Clarkston, WA 99403-1801 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2009 |
Last Update Date | 08/05/2019 |