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General NPI Number Information
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NPI Number | 1619670999
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Entity Type | Individual
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Provider Name | OLGA KISELOVA NP
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Gender | Female
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Dates
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Enumeration Date | 03/24/2023
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Last Update Date | 09/02/2024
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Provider Practice Location Address
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Address Line | 117 MARYS AVE
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City | KINGSTON
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State | NY
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Zip | 12401-5849
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Country | US
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Telephone | 845-383-1759
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Fax |
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Provider Business Mailing Address
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Address Line | 673 ACORN HILL RD
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City | OLIVEBRIDGE
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State | NY
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Zip | 12461-5443
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Country | US
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Telephone | 347-634-3076
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 350835
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License Number State | NY
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