Provider Demographics
NPI:1710862792
Name:KOVALCHUK, ARTEM
Entity type:Individual
Prefix:
First Name:ARTEM
Middle Name:
Last Name:KOVALCHUK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22304 NE HILLSIDE DR
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682-9751
Mailing Address - Country:US
Mailing Address - Phone:360-949-9988
Mailing Address - Fax:360-326-1939
Practice Address - Street 1:22304 NE HILLSIDE DR
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98682-9751
Practice Address - Country:US
Practice Address - Phone:360-949-9988
Practice Address - Fax:360-326-1939
Is Sole Proprietor?:No
Enumeration Date:2025-08-08
Last Update Date:2025-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN61502462163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse