MEDICARE: YELIZAVETA RUKHLOVA FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WL0100X	Lactation Consultant (Registered Nurse)	682563	NY
2	363LF0000X	Family Nurse Practitioner	F345593-01	NY

General Provider Information

NPI Number	:	1235765132
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YELIZAVETA RUKHLOVA FNP-BC

Provider Business Mailing Address
First Line	:	100 COLFAX AVE APT 6L
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10306-3332
Country	:	US
Telephone Number	:	347-462-6666
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 COLFAX AVE APT 6L
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10306-3332
Country	:	US
Telephone Number	:	347-462-6666
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2020
Last Update Date	:	03/23/2020

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