Provider Demographics
NPI:1063206969
Name:KOROLKOVAS BUITRON, LUDMILA (RN)
Entity type:Individual
Prefix:
First Name:LUDMILA
Middle Name:
Last Name:KOROLKOVAS BUITRON
Suffix:
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6520 BEACH FRONT RD APT B
Mailing Address - Street 2:
Mailing Address - City:ARVERNE
Mailing Address - State:NY
Mailing Address - Zip Code:11692-1293
Mailing Address - Country:US
Mailing Address - Phone:646-696-6999
Mailing Address - Fax:
Practice Address - Street 1:6520 BEACH FRONT RD APT B
Practice Address - Street 2:
Practice Address - City:ARVERNE
Practice Address - State:NY
Practice Address - Zip Code:11692-1293
Practice Address - Country:US
Practice Address - Phone:646-696-6999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY971250163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health