Provider Demographics
NPI:1639703267
Name:KHMELININA, OLGA (FNP-C)
Entity Type:Individual
Prefix:
First Name:OLGA
Middle Name:
Last Name:KHMELININA
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8735 INDEPENDENCE AVE APT 23
Mailing Address - Street 2:
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91304-6204
Mailing Address - Country:US
Mailing Address - Phone:323-973-3510
Mailing Address - Fax:
Practice Address - Street 1:8735 INDEPENDENCE AVE APT 23
Practice Address - Street 2:
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91304-6204
Practice Address - Country:US
Practice Address - Phone:323-973-3510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-21
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95013783363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care