Provider Demographics
NPI:1730587924
Name:GALENKO, ANTON FEDOROVICH
Entity type:Individual
Prefix:
First Name:ANTON
Middle Name:FEDOROVICH
Last Name:GALENKO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20109 21ST CT NE
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98155-1311
Mailing Address - Country:US
Mailing Address - Phone:206-455-4636
Mailing Address - Fax:206-366-2810
Practice Address - Street 1:20109 21ST CT NE
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98155-1311
Practice Address - Country:US
Practice Address - Phone:206-455-4636
Practice Address - Fax:206-366-2810
Is Sole Proprietor?:No
Enumeration Date:2014-12-20
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA376K00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program