Provider Demographics
NPI:1194314427
Name:EA NURSE PRACTITIONER IN ADULT HEALTH PC
Entity type:Organization
Organization Name:EA NURSE PRACTITIONER IN ADULT HEALTH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:OLGA
Authorized Official - Middle Name:
Authorized Official - Last Name:YUSHUVAYEVA
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:718-288-6075
Mailing Address - Street 1:228 GREENWAY RD
Mailing Address - Street 2:
Mailing Address - City:LIDO BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-4829
Mailing Address - Country:US
Mailing Address - Phone:718-288-6075
Mailing Address - Fax:
Practice Address - Street 1:228 GREENWAY RD
Practice Address - Street 2:
Practice Address - City:LIDO BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-4829
Practice Address - Country:US
Practice Address - Phone:718-288-6075
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty