Individual
TATYANA FETISOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1601 E 4TH PLAIN BLVD BLDG 17, VANCOUVER, WA 98661-3717
(360) 392-8246
Mailing address
4306 NE 158TH PL, VANCOUVER, WA 98682-7191
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LPN.LP.70059680.MSL
WA
Other
Enumeration date
05/27/2026
Last updated
05/27/2026
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