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NPI Code Detail

MEDICARE: VADIM KOVALEVICH CRNP

MEDICARE: VADIM KOVALEVICH CRNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse PractitionerSP024104PA

General Provider Information

NPI Number : 1477221752
Entity Type Code : Individual
Provider Name (Legal Business Name) : VADIM KOVALEVICH CRNP
Provider Business Mailing Address
First Line : 4102 AMHERST RD
Second Line :
City : ERIE
State : PA
Zip : 16506-5354
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2928 PEACH ST
Second Line :
City : ERIE
State : PA
Zip : 16508-1843
Country : US
Telephone Number : 814-453-6229
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/01/2021
Last Update Date : 09/01/2021

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Directions to “ VADIM KOVALEVICH CRNP” Practice Location

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