Provider Demographics
NPI:1538964705
Name:MIRONCHENKO, OLEG VIKTOR (DNP, APRN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:OLEG
Middle Name:VIKTOR
Last Name:MIRONCHENKO
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Gender:M
Credentials:DNP, APRN, PMHNP-BC
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:3320 PETERSON RD STE 104
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-1739
Mailing Address - Country:US
Mailing Address - Phone:785-371-1414
Mailing Address - Fax:785-371-4519
Practice Address - Street 1:3320 PETERSON RD STE 104
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-1739
Practice Address - Country:US
Practice Address - Phone:785-371-1414
Practice Address - Fax:785-371-4519
Is Sole Proprietor?:No
Enumeration Date:2025-02-13
Last Update Date:2025-11-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS5382879021363LP0808X
MO2024016173163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse