Healthcare Provider Details

I. General information

NPI: 1255620514
Provider Name (Legal Business Name): OKSANA HAIDAROVNA MULYUKOVA ND, EAMP, LAC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2011
Last Update Date: 11/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5410 S PINE ST
TACOMA WA
98409-6349
US

IV. Provider business mailing address

5410 S PINE ST
TACOMA WA
98409-6349
US

V. Phone/Fax

Practice location:
  • Phone: 425-273-4273
  • Fax:
Mailing address:
  • Phone: 425-273-4273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC60693435
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberNT60130357
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: