Provider Demographics
NPI:1366878795
Name:RUDNEVA, YELENA ALEXSANDRA
Entity type:Individual
Prefix:MISS
First Name:YELENA
Middle Name:ALEXSANDRA
Last Name:RUDNEVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELENA
Other - Middle Name:ALEXSANDRA
Other - Last Name:RUDNEVA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:12727 W 14TH AVE
Mailing Address - Street 2:
Mailing Address - City:AIRWAY HEIGHTS
Mailing Address - State:WA
Mailing Address - Zip Code:99001-9409
Mailing Address - Country:US
Mailing Address - Phone:509-244-4818
Mailing Address - Fax:
Practice Address - Street 1:12727 W 14TH AVE
Practice Address - Street 2:
Practice Address - City:AIRWAY HEIGHTS
Practice Address - State:WA
Practice Address - Zip Code:99001-9409
Practice Address - Country:US
Practice Address - Phone:509-244-4818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-17
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60373871225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist