Individual
TANIA ILIASHENKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2195 HARRODSBURG RD, LEXINGTON, KY 40504-3504
(859) 323-6712
Mailing address
2195 HARRODSBURG RD, LEXINGTON, KY 40504-3504
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
57302
KY
207Q00000X
Family Medicine Physician
R4988
KY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100680930
—
KY
Enumeration date
03/19/2019
Last updated
09/20/2022
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