Provider Demographics
NPI:1275542730
Name:MECHNYCZ, ODARKA - (APN)
Entity Type:Individual
Prefix:
First Name:ODARKA
Middle Name:-
Last Name:MECHNYCZ
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1808 SPRINGBROOK CT
Mailing Address - Street 2:
Mailing Address - City:WHIPPANY
Mailing Address - State:NJ
Mailing Address - Zip Code:07981-1428
Mailing Address - Country:US
Mailing Address - Phone:973-781-0734
Mailing Address - Fax:
Practice Address - Street 1:1808 SPRINGBROOK CT
Practice Address - Street 2:
Practice Address - City:WHIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07981-1428
Practice Address - Country:US
Practice Address - Phone:973-781-0734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NO04614800364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health