Healthcare Provider Details

I. General information

NPI: 1811501778
Provider Name (Legal Business Name): OKSANA KOLODICH CNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2020
Last Update Date: 09/08/2020
Certification Date: 09/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 MCINTOSH LN
CANDLER NC
28715
US

IV. Provider business mailing address

19 MCINTOSH LN
CANDLER NC
28715
US

V. Phone/Fax

Practice location:
  • Phone: 828-275-4296
  • Fax: 828-687-0583
Mailing address:
  • Phone: 828-275-4296
  • Fax: 828-687-0583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number527038
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: