Provider Demographics
NPI:1710558697
Name:VINNIK, OLGA (RN, BSN, IBCLC)
Entity Type:Individual
Prefix:
First Name:OLGA
Middle Name:
Last Name:VINNIK
Suffix:
Gender:F
Credentials:RN, BSN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 TERHUNE AVE
Mailing Address - Street 2:
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-2446
Mailing Address - Country:US
Mailing Address - Phone:862-295-2189
Mailing Address - Fax:
Practice Address - Street 1:414 TERHUNE AVE
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-2446
Practice Address - Country:US
Practice Address - Phone:862-295-2189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-01
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR1884100163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant