Provider Demographics
NPI:1568747038
Name:GAVRILENKO, OLGA N (NP)
Entity Type:Individual
Prefix:
First Name:OLGA
Middle Name:N
Last Name:GAVRILENKO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1091 KEMPTON RUN DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-3508
Mailing Address - Country:US
Mailing Address - Phone:614-506-9378
Mailing Address - Fax:614-844-5735
Practice Address - Street 1:6674 WESTON CIR W
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016-7901
Practice Address - Country:US
Practice Address - Phone:614-595-1055
Practice Address - Fax:614-873-2040
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-17
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OHCOA.12424-NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health