Healthcare Provider Details

I. General information

NPI: 1699167452
Provider Name (Legal Business Name): LYUDMILA ZHIRNOVA R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2015
Last Update Date: 03/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 FARM RD SIDE
SHOREHAM NY
11786-1551
US

IV. Provider business mailing address

3 FARM RD SIDE
SHOREHAM NY
11786-1551
US

V. Phone/Fax

Practice location:
  • Phone: 347-631-6791
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number6761541
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: