Healthcare Provider Details

I. General information

NPI: 1821657248
Provider Name (Legal Business Name): OLGA N GOLDINOV FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2019
Last Update Date: 04/07/2021
Certification Date: 04/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 SE 164TH AVE STE 300
VANCOUVER WA
98684-8944
US

IV. Provider business mailing address

8101 NE 86TH AVE
VANCOUVER WA
98662-2894
US

V. Phone/Fax

Practice location:
  • Phone: 360-896-6944
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN60209371
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201909239NP-PP
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP61008319
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: