Provider Demographics
NPI:1124503941
Name:ORLOVA, SVETLANA
Entity type:Individual
Prefix:
First Name:SVETLANA
Middle Name:
Last Name:ORLOVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SVELTANA
Other - Middle Name:
Other - Last Name:ORLOVA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:11357 NW VALROS LN
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-5081
Mailing Address - Country:US
Mailing Address - Phone:360-852-0350
Mailing Address - Fax:
Practice Address - Street 1:308 NW 11TH AVE FL 2
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-2980
Practice Address - Country:US
Practice Address - Phone:360-852-0350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-27
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201911415NP-PP363LP0808X
WAAP60877644163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health