Provider Demographics
NPI:1396251815
Name:MAKAROVA, VIKTORIYA (CRNP)
Entity type:Individual
Prefix:
First Name:VIKTORIYA
Middle Name:
Last Name:MAKAROVA
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 N BROAD ST APT 2F
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-2250
Mailing Address - Country:US
Mailing Address - Phone:215-920-0070
Mailing Address - Fax:
Practice Address - Street 1:810 N BROAD ST APT 2F
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19130-2250
Practice Address - Country:US
Practice Address - Phone:215-920-0070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-20
Last Update Date:2017-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP018354363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner