Provider Demographics
NPI:1487443768
Name:VANCHUGOVA, IRYNA N/A
Entity type:Individual
Prefix:
First Name:IRYNA
Middle Name:N/A
Last Name:VANCHUGOVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17600 14TH AVE N APT 106
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55447-2948
Mailing Address - Country:US
Mailing Address - Phone:763-245-8436
Mailing Address - Fax:763-245-8436
Practice Address - Street 1:2 PINE TREE DR
Practice Address - Street 2:
Practice Address - City:ARDEN HILLS
Practice Address - State:MN
Practice Address - Zip Code:55112-3754
Practice Address - Country:US
Practice Address - Phone:651-635-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-03
Last Update Date:2025-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical