Provider Demographics
NPI:1619415015
Name:MISHCHENKO, GALYNA (FNP)
Entity Type:Individual
Prefix:
First Name:GALYNA
Middle Name:
Last Name:MISHCHENKO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 839
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95341-0839
Mailing Address - Country:US
Mailing Address - Phone:209-383-5200
Mailing Address - Fax:209-383-5700
Practice Address - Street 1:936 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-4519
Practice Address - Country:US
Practice Address - Phone:209-383-5200
Practice Address - Fax:209-383-5700
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-06
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95005496363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner