MEDICARE: OLGA VERKHOVSKY NP

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	363L00000X	Nurse Practitioner	540274	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	540274	OTHER	CA	STATE LCIENSE

General Provider Information

NPI Number	:	1629099874
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLGA VERKHOVSKY NP

Provider Business Mailing Address
First Line	:	PO BOX 91989
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90809-1989
Country	:	US
Telephone Number	:	818-705-1239
Fax Number	:	818-705-0448

Provider Business Practice Location Address
First Line	:	2650 ELM AVE
Second Line	:	STE 218
City	:	LONG BEACH
State	:	CA
Zip	:	90806-1651
Country	:	US
Telephone Number	:	818-705-1239
Fax Number	:	818-705-0448

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

Provider Enumeration Date	:	07/22/2006
Last Update Date	:	07/08/2007

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