MEDICARE: OLHA LYSENKO RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WG0000X	General Practice Registered Nurse	95410886	CA

General Provider Information

NPI Number	:	1336074632
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLHA LYSENKO RN

Provider Business Mailing Address
First Line	:	8131 WALERGA RD APT 828
Second Line	:
City	:	ANTELOPE
State	:	CA
Zip	:	95843-6149
Country	:	US
Telephone Number	:	916-406-4916
Fax Number	:

Provider Business Practice Location Address
First Line	:	8131 WALERGA RD APT 828
Second Line	:
City	:	ANTELOPE
State	:	CA
Zip	:	95843-6149
Country	:	US
Telephone Number	:	916-406-4916
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2026
Last Update Date	:	06/17/2026

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