Basic Information
| Provider Information | |||||||||
| NPI: | 1497202915 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MACHKOVSKY | ||||||||
| FirstName: | ELVIRA | ||||||||
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| Credential: | FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2000 SIERRA ROAD | ||||||||
| Address2: | |||||||||
| City: | CONCORD | ||||||||
| State: | CALIFORNIA | ||||||||
| PostalCode: | 94518 | ||||||||
| CountryCode: | UM | ||||||||
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| Practice Location | |||||||||
| Address1: | 2000 SIERRA RD | ||||||||
| Address2: | |||||||||
| City: | CONCORD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94518 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9253632000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/01/2016 | ||||||||
| LastUpdateDate: | 09/01/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 95003865 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 95003865 | 01 | CA | FAMILY NURSE PRACTITIONER CERTIFICATE | OTHER | 666426 | 01 | CA | RN CERTIFICATE | OTHER |