Healthcare Provider Details

I. General information

NPI: 1992989305
Provider Name (Legal Business Name): TATYANA A KUSHNIRENKO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2007
Last Update Date: 03/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6400 LAUREL CANYON BLVD SUITE 610
NORTH HOLLYWOOD CA
91606-1571
US

IV. Provider business mailing address

6400 LAUREL CANYON BLVD SUITE 610
NORTH HOLLYWOOD CA
91606-1571
US

V. Phone/Fax

Practice location:
  • Phone: 818-509-0022
  • Fax: 818-509-0044
Mailing address:
  • Phone: 818-509-0022
  • Fax: 818-509-0044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number17653
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number592600
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: