Provider Demographics
NPI:1376195263
Name:RYBAKOV, OLGA A (NURSE PRACTIONER)
Entity Type:Individual
Prefix:MRS
First Name:OLGA
Middle Name:A
Last Name:RYBAKOV
Suffix:
Gender:F
Credentials:NURSE PRACTIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 GRAND ROAD SUITE B-2
Mailing Address - Street 2:
Mailing Address - City:EAST WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98802-7723
Mailing Address - Country:US
Mailing Address - Phone:509-888-6334
Mailing Address - Fax:509-436-0046
Practice Address - Street 1:230 GRAND ROAD SUITE B-2
Practice Address - Street 2:
Practice Address - City:EAST WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98802-7723
Practice Address - Country:US
Practice Address - Phone:509-888-6334
Practice Address - Fax:509-436-0046
Is Sole Proprietor?:No
Enumeration Date:2019-07-11
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00160346163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant