Healthcare Provider Details

I. General information

NPI: 1376972539
Provider Name (Legal Business Name): IRINA BUKSHTEYN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2013
Last Update Date: 05/24/2022
Certification Date: 05/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 S MAIN ST STE B3
ALPHARETTA GA
30009-1958
US

IV. Provider business mailing address

3565 BARDFIELD CT
CUMMING GA
30041-7334
US

V. Phone/Fax

Practice location:
  • Phone: 404-836-9906
  • Fax: 470-545-4768
Mailing address:
  • Phone: 770-309-9990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN202943
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: