Provider Demographics
NPI:1083209266
Name:IANTSEVYCH, NATALIIA (FNP)
Entity type:Individual
Prefix:
First Name:NATALIIA
Middle Name:
Last Name:IANTSEVYCH
Suffix:
Gender:
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92 CAMPUS DR STE C
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-7229
Mailing Address - Country:US
Mailing Address - Phone:207-797-5753
Mailing Address - Fax:207-797-9571
Practice Address - Street 1:92 CAMPUS DR STE C
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-7229
Practice Address - Country:US
Practice Address - Phone:207-797-5753
Practice Address - Fax:207-797-9571
Is Sole Proprietor?:No
Enumeration Date:2021-03-09
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP211076363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME211076OtherLICENSE
ME363LF0000XMedicaid