Healthcare Provider Details

I. General information

NPI: 1255875860
Provider Name (Legal Business Name): OLGA GUDALEVICH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2016
Last Update Date: 10/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33840 AURORA RD
SOLON OH
44139-3700
US

IV. Provider business mailing address

36700 PEPPER DR
SOLON OH
44139-2477
US

V. Phone/Fax

Practice location:
  • Phone: 866-389-2727
  • Fax:
Mailing address:
  • Phone: 866-389-2727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.398745
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.021167
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: