Basic Information
| Provider Information | |||||||||
| NPI: | 1336210202 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SEMENYUK | ||||||||
| FirstName: | LESYA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5410 MARYLAND WAY | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | BRENTWOOD | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370275064 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153775670 | ||||||||
| FaxNumber: | 6153771678 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 NE MOTHER JOSEPH PL | ||||||||
| Address2: | |||||||||
| City: | VANCOUVER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986643200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3605143727 | ||||||||
| FaxNumber: | 3605143711 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/13/2006 | ||||||||
| LastUpdateDate: | 07/12/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD00043437 | WA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | P00177644 | 01 | WA | RAILROAD MEDICARE | OTHER | 8389686 | 05 | WA | MEDICAID |