Healthcare Provider Details

I. General information

NPI: 1508464264
Provider Name (Legal Business Name): OKSANA YOVCHENKO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2020
Last Update Date: 12/09/2023
Certification Date: 12/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1811 HONE AVE
BRONX NY
10461-1406
US

IV. Provider business mailing address

6295 SAUNDERS ST APT 4N
REGO PARK NY
11374-1573
US

V. Phone/Fax

Practice location:
  • Phone: 516-499-9016
  • Fax:
Mailing address:
  • Phone: 347-998-5988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number706141
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number311458
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: