Basic Information
| Provider Information | |||||||||
| NPI: | 1386763076 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | IVANOVA | ||||||||
| FirstName: | ISKRA | ||||||||
| MiddleName: | IVANOVA | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 123 2ND AVE N | ||||||||
| Address2: | APT. 526 | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981094995 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 123 2ND AVE N | ||||||||
| Address2: | APT. 526 | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981094995 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2069873996 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2007 | ||||||||
| LastUpdateDate: | 03/22/2017 | ||||||||
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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 | 207L00000X | MT183412 | PA | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207LP3000X | MD60057958 | WA | Y | Allopathic & Osteopathic Physicians | Anesthesiology | Pediatric Anesthesiology |
No ID Information.