Provider Demographics
NPI:1285187997
Name:JURINCIE, NATALIYA
Entity type:Individual
Prefix:
First Name:NATALIYA
Middle Name:
Last Name:JURINCIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3999 N WAKEFIELD DR
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-6733
Mailing Address - Country:US
Mailing Address - Phone:928-273-9600
Mailing Address - Fax:
Practice Address - Street 1:3999 N WAKEFIELD DR
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-6733
Practice Address - Country:US
Practice Address - Phone:928-273-9600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-28
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor