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General NPI Number Information
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NPI Number | 1104402452
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Entity Type | Individual
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Provider Name | IRYNA ZHUKOUSKAYA NP
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Gender | Female
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Dates
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Enumeration Date | 03/18/2021
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Last Update Date | 03/17/2025
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Provider Practice Location Address
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Address Line | 736 CAMBRIDGE ST FL 2
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City | BRIGHTON
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State | MA
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Zip | 02135-2907
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Country | US
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Telephone | 161-778-9242
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Fax |
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Provider Business Mailing Address
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Address Line | 960 MASSACHUSETTS AVE STE 2
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City | BOSTON
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State | MA
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Zip | 02118-2690
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Country | US
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Telephone | 617-414-4505
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | NP2268299
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License Number State | MA
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