Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 228852 | MA |
N | 2080P0210X | Pediatric Nephrologist | 234150 | MA |
N | 2080P0210X | Pediatric Nephrologist | 42535 | TX |
Y | 2080P0210X | Pediatric Nephrologist | N8070 | TX |
NPI | 1255542023 |
---|---|
Provider Name | Tetyana L Vasylyeva |
First Address | Amarillo, TX 79106-1708 |
Second Address | Amarillo, TX 79106-1786 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2007 |
Last Update Date | 10/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
198943601 | (05) | TX |
198943602 | (05) | TX |
200232360A | (05) | OK |
73730785 | (05) | NM |