Individual
ELENA IVANOVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1108 W INDIAN SCHOOL RD, STE B, PHOENIX, AZ 85013
(602) 773-5600
(602) 773-5601
Mailing address
1108 W INDIAN SCHOOL RD, STE B, PHOENIX, AZ 85013-3107
(602) 773-5600
(602) 773-5601
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
AP7748
AZ
Other
Enumeration date
04/16/2015
Last updated
01/30/2017
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