Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 26NJ00637500 | NJ |
N | 363LG0600X | Nurse Practitioner - Gerontology | 26NJ00637500 | NJ |
N | 363LP2300X | Nurse Practitioner - Primary Care | 26NJ00637500 | NJ |
NPI | 1023561149 |
---|---|
Provider Name | Yelena Ovcharik |
First Address | Fort Lee, NJ 07024-2404 |
Second Address | Paterson, NJ 07503-2621 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2016 |
Last Update Date | 30/08/2016 |