Healthcare Provider Details

I. General information

NPI: 1316266604
Provider Name (Legal Business Name): NATALYA Y KOLESNIKOVA RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2010
Last Update Date: 05/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10180 SE SUNNYSIDE RD
CLACKAMAS OR
97015-8970
US

IV. Provider business mailing address

10180 SE SUNNYSIDE RD
CLACKAMAS OR
97015-8970
US

V. Phone/Fax

Practice location:
  • Phone: 503-652-2880
  • Fax:
Mailing address:
  • Phone: 503-652-2880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279C0205X
TaxonomyCritical Care Registered Respiratory Therapist
License NumberRT-P-10121372
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: