Provider Demographics
NPI:1427784669
Name:ONISHCHENKO, OLIVIA (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:ONISHCHENKO
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:938 REMINGTON DR
Mailing Address - Street 2:
Mailing Address - City:NORTH TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-2947
Mailing Address - Country:US
Mailing Address - Phone:716-704-2464
Mailing Address - Fax:
Practice Address - Street 1:938 REMINGTON DR
Practice Address - Street 2:
Practice Address - City:NORTH TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14120-2947
Practice Address - Country:US
Practice Address - Phone:716-704-2464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-29
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY79851101163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse