Provider Demographics
NPI:1992989305
Name:KUSHNIRENKO, TATYANA A (NP)
Entity type:Individual
Prefix:
First Name:TATYANA
Middle Name:A
Last Name:KUSHNIRENKO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 LAUREL CANYON BLVD
Mailing Address - Street 2:SUITE 610
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-1571
Mailing Address - Country:US
Mailing Address - Phone:818-509-0022
Mailing Address - Fax:818-509-0044
Practice Address - Street 1:6400 LAUREL CANYON BLVD
Practice Address - Street 2:SUITE 610
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-1571
Practice Address - Country:US
Practice Address - Phone:818-509-0022
Practice Address - Fax:818-509-0044
Is Sole Proprietor?:No
Enumeration Date:2007-12-20
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA592600163W00000X
CA17653363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse