Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | MD61000139 | WA |
N | 207QA0505X | Family Doctor - Adult Medicine | P97165 | NY |
NPI | 1255798260 |
---|---|
Provider Name | Kateryna Mykhalchenko |
First Address | Everett, WA 98206-5127 |
Second Address | Everett, WA 98201-4833 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/01/2016 |
Last Update Date | 09/09/2020 |