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General NPI Number Information
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NPI Number | 1396465001
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Entity Type | Individual
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Provider Name | VERA NIKOLAYCHUK CPNP-PC
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Gender | Female
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Dates
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Enumeration Date | 09/01/2022
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Last Update Date | 09/01/2022
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Provider Practice Location Address
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Address Line | 7910 FROST ST STE 335
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City | SAN DIEGO
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State | CA
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Zip | 92123-2753
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Country | US
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Telephone | 858-576-8010
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Fax |
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Provider Business Mailing Address
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Address Line | 1110 24TH ST APT 25
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City | SAN DIEGO
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State | CA
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Zip | 92102-2046
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Country | US
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Telephone | 916-346-6039
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 95021840
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License Number State | CA
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