Individual
MARIYA TKACHENKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
1415 SAINT FRANCIS AVE, SHAKOPEE, MN 55379-3374
(952) 993-7750
Mailing address
8170 33RD AVE S # MS 21110Q, BLOOMINGTON, MN 55425-4516
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
11902
MN
363LF0000X
Family Nurse Practitioner
Primary
11902
MN
Other
Enumeration date
08/01/2024
Last updated
09/09/2024
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