| NPI | 1841533601 |
|---|---|
| Former Name | LYDIA KOSTRUKOFF |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 276394) |
| Additional Taxonomies | 163WM0705X Registered Nurse, Medical-Surgical (Licence: CA 276394) |
| Enumeration Date | 2013-03-30 |
| Last Update Date | 2013-03-30 |