Healthcare Provider Details

I. General information

NPI: 1831694967
Provider Name (Legal Business Name): INNA LEMESHKO NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2018
Last Update Date: 06/05/2023
Certification Date: 06/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18646 OXNARD ST
TARZANA CA
91356-1411
US

IV. Provider business mailing address

11235 AMESTOY AVE
GRANADA HILLS CA
91344-4112
US

V. Phone/Fax

Practice location:
  • Phone: 818-996-1051
  • Fax: 818-975-5039
Mailing address:
  • Phone: 818-996-1051
  • Fax: 818-975-5039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number592970
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNP95023978
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: