Individual
MRS. MARIYA L GUSENKOV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
34509 9TH AVE S, SUITE 306, FEDERAL WAY, WA 98003-6700
(253) 838-1520
(253) 838-4933
Mailing address
34509 9TH AVE S, SUITE 306, FEDERAL WAY, WA 98003-6700
(253) 838-1520
(253) 838-4933
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
AP30006345
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2159GU
REGENCE BLUE SHIELD
WA
05
—
9636481
—
WA
Enumeration date
04/25/2007
Last updated
07/09/2007
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