Healthcare Provider Details

I. General information

NPI: 1518772656
Provider Name (Legal Business Name): OLGA RAKHMANOVA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2025
Last Update Date: 02/07/2025
Certification Date: 02/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7503 182ND ST
FRESH MEADOWS NY
11366-1613
US

IV. Provider business mailing address

7503 182ND ST
FRESH MEADOWS NY
11366-1613
US

V. Phone/Fax

Practice location:
  • Phone: 347-369-1797
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number311867
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: