Ivanova, Yelena
Ivanova, Yelena is an sole proprietor health care provider with primary practice located at 4100 52Nd St , Kenosha WI 53144-3900. She recently has only one registered license in Pharmacy Service Providers / Pharmacist, which is considered as her primary health care specialty. Ivanova, Yelena can be contacted via phone (262) 658-0902.Contact Information
Primary practice address
4100 52Nd St
Kenosha WI 53144-3900
Phone: (262) 658-0902
Fax: (262) 658-0560
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Pharmacy Service Providers / Pharmacist | 183500000X | 15104 | Wisconsin |
Profile Details
| NPI number | 1265754485 |
|---|---|
| LBN Legal business name | Ivanova, Yelena |
| Credentials | |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Feb 16th, 2010 |
| Last updated | Feb 16th, 2010 - about 14 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1265754485 | NPPES |
| Wisconsin | MEDICAID | 33014500 |
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