Provider Demographics
NPI:1528324316
Name:PRONCHENKO, YULIA (MED)
Entity type:Individual
Prefix:
First Name:YULIA
Middle Name:
Last Name:PRONCHENKO
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 W HICKORY ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-4156
Mailing Address - Country:US
Mailing Address - Phone:940-435-9037
Mailing Address - Fax:
Practice Address - Street 1:207 W HICKORY ST
Practice Address - Street 2:SUITE 110
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-4156
Practice Address - Country:US
Practice Address - Phone:940-435-9037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-05
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67160390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program