Healthcare Provider Details

I. General information

NPI: 1790518306
Provider Name (Legal Business Name): OXANA DJALILOV FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2024
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5325 NORTHGATE DR STE 200
BETHLEHEM PA
18017-9413
US

IV. Provider business mailing address

5325 NORTHGATE DR STE 200
BETHLEHEM PA
18017-9413
US

V. Phone/Fax

Practice location:
  • Phone: 484-222-4646
  • Fax:
Mailing address:
  • Phone: 484-222-4646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number355290
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number783609
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: