Provider Demographics
NPI:1366976128
Name:OSTAPENKO, YULIYA (NP)
Entity type:Individual
Prefix:
First Name:YULIYA
Middle Name:
Last Name:OSTAPENKO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5427 BENTLEY RD
Mailing Address - Street 2:APT 201
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-2179
Mailing Address - Country:US
Mailing Address - Phone:248-245-2011
Mailing Address - Fax:
Practice Address - Street 1:5427 BENTLEY RD
Practice Address - Street 2:APT 201
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-2179
Practice Address - Country:US
Practice Address - Phone:248-245-2011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-18
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704291620363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily