Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | SP019246 | PA |
N | 363LP2300X | Nurse Practitioner - Primary Care | SP019246 | PA |
NPI | 1003390444 |
---|---|
Provider Name | Tatyana Kryachkov |
First Address | Erie, PA 16505-3691 |
Second Address | Erie, PA 16505-3691 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2018 |
Last Update Date | 21/10/2020 |