Provider Demographics
NPI:1427378983
Name:KRYUKOVA, NATALIA M (LMP)
Entity type:Individual
Prefix:
First Name:NATALIA
Middle Name:M
Last Name:KRYUKOVA
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 NE 4TH PLAIN BLVD.
Mailing Address - Street 2:STE E104
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661
Mailing Address - Country:US
Mailing Address - Phone:360-737-9665
Mailing Address - Fax:360-737-9634
Practice Address - Street 1:5000 NE 4TH PLAIN BLVD.
Practice Address - Street 2:STE E104
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661
Practice Address - Country:US
Practice Address - Phone:360-737-9665
Practice Address - Fax:360-737-9634
Is Sole Proprietor?:No
Enumeration Date:2010-06-08
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60151211225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist