Healthcare Provider Details

I. General information

NPI: 1093271413
Provider Name (Legal Business Name): YELENA Y BOGUSLAVSKY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2019
Last Update Date: 05/02/2021
Certification Date: 05/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2841 RIVER RD W
GOOCHLAND VA
23063-3200
US

IV. Provider business mailing address

702 W CLAY ST
RICHMOND VA
23220-3114
US

V. Phone/Fax

Practice location:
  • Phone: 804-556-7500
  • Fax:
Mailing address:
  • Phone: 540-371-0079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number0024176950
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: