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General NPI Number Information
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NPI Number | 1285334979
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Entity Type | Individual
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Provider Name | NATALLIA PETRUSHENKA
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Gender | Female
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Dates
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Enumeration Date | 03/09/2023
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Last Update Date | 11/14/2023
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Provider Practice Location Address
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Address Line | 444 STOCKBRIDGE RD
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City | GREAT BARRINGTON
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State | MA
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Zip | 01230-1295
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Country | US
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Telephone | 413-528-9311
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Fax |
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Provider Business Mailing Address
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Address Line | 1200 HILLSIDE AVE APT 501
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City | NISKAYUNA
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State | NY
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Zip | 12309-3559
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Country | US
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Telephone | 929-428-1102
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DN1860022
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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