Healthcare Provider Details

I. General information

NPI: 1699040477
Provider Name (Legal Business Name): JANET SUSAN OLONKO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2012
Last Update Date: 03/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6015 18TH AVE
BROOKLYN NY
11204-2204
US

IV. Provider business mailing address

6015 18TH AVE
BROOKLYN NY
11204-2204
US

V. Phone/Fax

Practice location:
  • Phone: 718-837-7724
  • Fax: 718-837-7724
Mailing address:
  • Phone: 718-837-7724
  • Fax: 718-837-7724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number260912-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: