Healthcare Provider Details

I. General information

NPI: 1538946249
Provider Name (Legal Business Name): ANNA KUZNETSOV DNP, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2023
Last Update Date: 02/07/2025
Certification Date: 02/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 N 7TH ST
CHENEY WA
99004-2220
US

IV. Provider business mailing address

19 N 7TH ST
CHENEY WA
99004-2220
US

V. Phone/Fax

Practice location:
  • Phone: 509-325-6151
  • Fax:
Mailing address:
  • Phone: 509-235-6151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP61481809
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAP61481809
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: