Provider Demographics
NPI:1780999177
Name:ISHKOVA-VOLOVETS, NATALIYA (NP)
Entity type:Individual
Prefix:
First Name:NATALIYA
Middle Name:
Last Name:ISHKOVA-VOLOVETS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6120 EARLE BROWN DR STE 100
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55430-4100
Mailing Address - Country:US
Mailing Address - Phone:763-537-6612
Mailing Address - Fax:763-537-7162
Practice Address - Street 1:6120 EARLE BROWN DR STE 100
Practice Address - Street 2:
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55430-4100
Practice Address - Country:US
Practice Address - Phone:763-537-6612
Practice Address - Fax:763-537-7162
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-10
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6396363L00000X
MNR155507-5363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner