MEDICARE: MRS. MARGARITA ILYASOVA RN

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
1	163W00000X	Registered Nurse	810496	NY

General Provider Information

NPI Number	:	1750011466
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARGARITA ILYASOVA RN

Provider Business Mailing Address
First Line	:	8317 125TH ST
Second Line	:
City	:	KEW GARDENS
State	:	NY
Zip	:	11415-2705
Country	:	US
Telephone Number	:	929-939-7667
Fax Number	:

Provider Business Practice Location Address
First Line	:	8317 125TH ST
Second Line	:
City	:	KEW GARDENS
State	:	NY
Zip	:	11415-2705
Country	:	US
Telephone Number	:	929-939-7667
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2022
Last Update Date	:	06/15/2022

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