Healthcare Provider Details

I. General information

NPI: 1134874027
Provider Name (Legal Business Name): NATALY KUZNETSOV PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2022
Last Update Date: 09/15/2023
Certification Date: 09/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 FRANKLIN ST STE 8
NAPA CA
94559-2949
US

IV. Provider business mailing address

833 FRANKLIN ST STE 8
NAPA CA
94559-2949
US

V. Phone/Fax

Practice location:
  • Phone: 530-625-7738
  • Fax: 530-862-4238
Mailing address:
  • Phone: 530-625-7738
  • Fax: 530-862-4238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95020035
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: