Provider Demographics
NPI:1386437002
Name:KRIVORUCHKO, LILIYA (FNP)
Entity type:Individual
Prefix:
First Name:LILIYA
Middle Name:
Last Name:KRIVORUCHKO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4237 CLOVER KNOLL CT
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-6734
Mailing Address - Country:US
Mailing Address - Phone:916-838-6322
Mailing Address - Fax:
Practice Address - Street 1:6500 COYLE AVE STE 4
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-0301
Practice Address - Country:US
Practice Address - Phone:916-838-6322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-26
Last Update Date:2025-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95035170363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily