Healthcare Provider Details

I. General information

NPI: 1144919754
Provider Name (Legal Business Name): YEKATERINA M YEPIFANOVA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2023
Last Update Date: 05/31/2023
Certification Date: 05/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 LAMB CIR
CHRISTIANSBURG VA
24073-6347
US

IV. Provider business mailing address

1789 MOUNTAINSIDE DR
BLACKSBURG VA
24060-9201
US

V. Phone/Fax

Practice location:
  • Phone: 540-639-5888
  • Fax:
Mailing address:
  • Phone: 540-314-6492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024187246
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: