Provider Demographics
NPI:1629099874
Name:VERKHOVSKY, OLGA (NP)
Entity Type:Individual
Prefix:
First Name:OLGA
Middle Name:
Last Name:VERKHOVSKY
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:PO BOX 91989
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90809-1989
Mailing Address - Country:US
Mailing Address - Phone:818-705-1239
Mailing Address - Fax:818-705-0448
Practice Address - Street 1:2650 ELM AVE
Practice Address - Street 2:STE 218
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-1651
Practice Address - Country:US
Practice Address - Phone:818-705-1239
Practice Address - Fax:818-705-0448
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA540274363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA540274OtherSTATE LCIENSE