Provider Demographics
NPI:1629254883
Name:NAKONECHNA, OLENA (MD)
Entity Type:Individual
Prefix:
First Name:OLENA
Middle Name:
Last Name:NAKONECHNA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3706 S 1ST ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-7046
Mailing Address - Country:US
Mailing Address - Phone:512-324-4973
Mailing Address - Fax:512-324-4948
Practice Address - Street 1:3706 S 1ST ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-7046
Practice Address - Country:US
Practice Address - Phone:512-324-4973
Practice Address - Fax:512-324-4948
Is Sole Proprietor?:No
Enumeration Date:2008-01-17
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1966208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8D9219OtherMEDICARE
TX1744872-04Medicaid