Provider Demographics
NPI:1871351981
Name:MISHUK, EKATERINA
Entity type:Individual
Prefix:MRS
First Name:EKATERINA
Middle Name:
Last Name:MISHUK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 DOMINIC DR
Mailing Address - Street 2:
Mailing Address - City:MONROE TWP
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-4441
Mailing Address - Country:US
Mailing Address - Phone:510-366-7862
Mailing Address - Fax:
Practice Address - Street 1:17 DOMINIC DR
Practice Address - Street 2:
Practice Address - City:MONROE TWP
Practice Address - State:NJ
Practice Address - Zip Code:08831-4441
Practice Address - Country:US
Practice Address - Phone:510-366-7862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-12
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR15388400163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse