Provider Demographics
NPI:1386296887
Name:STESHENKO, NATALIIA (PHYSICIAN EXTENDER)
Entity type:Individual
Prefix:
First Name:NATALIIA
Middle Name:
Last Name:STESHENKO
Suffix:
Gender:F
Credentials:PHYSICIAN EXTENDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 E TERRA COTTA AVE STE C
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-3621
Mailing Address - Country:US
Mailing Address - Phone:847-639-5800
Mailing Address - Fax:
Practice Address - Street 1:750 E TERRA COTTA AVE STE C
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-3621
Practice Address - Country:US
Practice Address - Phone:847-639-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-15
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL238.000631246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant