Provider Demographics
NPI:1992277248
Name:DINOVETSKIY, OLEG
Entity type:Individual
Prefix:
First Name:OLEG
Middle Name:
Last Name:DINOVETSKIY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:358 SHADY WOODS LN
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORDTON
Mailing Address - State:NC
Mailing Address - Zip Code:28139-2768
Mailing Address - Country:US
Mailing Address - Phone:828-447-5523
Mailing Address - Fax:828-286-1427
Practice Address - Street 1:542 FOREST LAKE RD
Practice Address - Street 2:
Practice Address - City:FOREST CITY
Practice Address - State:NC
Practice Address - Zip Code:28043-5112
Practice Address - Country:US
Practice Address - Phone:828-447-5523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-27
Last Update Date:2018-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL-081-054374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide