Healthcare Provider Details

I. General information

NPI: 1841820453
Provider Name (Legal Business Name): OLGA ZHIRNOVA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2020
Last Update Date: 01/22/2020
Certification Date: 01/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19611 7TH AVE NE STE 200
POULSBO WA
98370-7384
US

IV. Provider business mailing address

19589 FRONT ST NE APT 200
POULSBO WA
98370-7363
US

V. Phone/Fax

Practice location:
  • Phone: 360-271-3740
  • Fax:
Mailing address:
  • Phone: 360-271-3740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number61033415
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: