Provider Demographics
NPI:1669855029
Name:FEDORENKO, OLGA (ACRN)
Entity Type:Individual
Prefix:MRS
First Name:OLGA
Middle Name:
Last Name:FEDORENKO
Suffix:
Gender:F
Credentials:ACRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 CARLSON ST
Mailing Address - Street 2:
Mailing Address - City:COVENTRY
Mailing Address - State:RI
Mailing Address - Zip Code:02816-6033
Mailing Address - Country:US
Mailing Address - Phone:401-823-0244
Mailing Address - Fax:
Practice Address - Street 1:15 CARLSON ST
Practice Address - Street 2:
Practice Address - City:COVENTRY
Practice Address - State:RI
Practice Address - Zip Code:02816-6033
Practice Address - Country:US
Practice Address - Phone:401-823-0244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-02
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAPRN00700363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily