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General NPI Number Information
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NPI Number | 1710476155
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Entity Type | Individual
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Provider Name | VLADIMIR A KOSTYURENKO
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Gender | Male
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Dates
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Enumeration Date | 05/01/2018
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Last Update Date | 11/20/2025
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Provider Practice Location Address
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Address Line | 4301 W MARKHAM ST # 531
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City | LITTLE ROCK
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State | AR
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Zip | 72205-7101
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Country | US
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Telephone | 501-686-8818
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Fax | 501-526-7217
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Provider Business Mailing Address
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Address Line | 11001 EXECUTIVE CENTER DR STE 200
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City | LITTLE ROCK
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State | AR
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Zip | 72211-4393
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Country | US
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Telephone | 501-812-7215
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Fax | 501-812-7207
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | APRN11019502
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | C003256
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License Number State | AR
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Taxonomy #3
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | AP61231826
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License Number State | WA
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