MEDICARE: OKSANA LIDKE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	4704290342	MI

General Provider Information

NPI Number	:	1427512425
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OKSANA LIDKE

Provider Business Mailing Address
First Line	:	18753 174TH AVE
Second Line	:
City	:	SPRING LAKE
State	:	MI
Zip	:	49456-9772
Country	:	US
Telephone Number	:	231-246-5252
Fax Number	:

Provider Business Practice Location Address
First Line	:	395 S SHORE DR
Second Line	:
City	:	BATTLE CREEK
State	:	MI
Zip	:	49014-5466
Country	:	US
Telephone Number	:	947-217-3212
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/24/2019
Last Update Date	:	02/06/2024

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Directions to “ OKSANA LIDKE ” Practice Location

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