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General NPI Number Information
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NPI Number | 1699066373
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Entity Type | Individual
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Provider Name | KATERYNA IVANOVA D.O.
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Gender | Female
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Dates
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Enumeration Date | 04/28/2011
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Last Update Date | 04/26/2019
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Provider Practice Location Address
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Address Line | 474 N YELLOW SPRINGS STREET
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City | SPRINGFIELD
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State | OH
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Zip | 45504-2938
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Country | US
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Telephone | 937-399-9500
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Fax |
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Provider Business Mailing Address
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Address Line | 807 WEST AVE
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City | AUSTIN
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State | TX
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Zip | 78701-2207
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Country | US
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Telephone | 888-285-2269
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Fax | 512-838-4264
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 63625
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | Q3892
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 19-321
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License Number State | WI
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Taxonomy #4
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | OP60851495
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License Number State | WA
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Taxonomy #5
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | DO187158
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License Number State | OR
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Taxonomy #6
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 20190133398
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License Number State | MO
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Taxonomy #7
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 26323
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License Number State | MS
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Taxonomy #8
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 34.011156
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License Number State | OH
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