Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 677468 | NY |
NPI | 1013579614 |
---|---|
Provider Name | Olga Yushuvayeva |
First Address | New Hyde Park, NY 11040-3031 |
Second Address | Brooklyn, NY 11207-4101 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2019 |
Last Update Date | 03/07/2019 |