Individual
KHRYSTYNA ANTONOVA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
15552 57TH PL N, PLYMOUTH, MN 55446-3737
(612) 481-1842
Mailing address
15552 57TH PL N, PLYMOUTH, MN 55446-3737
(612) 481-1842
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
7317
MN
Other
Enumeration date
12/03/2021
Last updated
12/03/2021
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