Provider Demographics
NPI:1740750330
Name:JELEN, SVETLANA (RN, ANP)
Entity Type:Individual
Prefix:MRS
First Name:SVETLANA
Middle Name:
Last Name:JELEN
Suffix:
Gender:F
Credentials:RN, ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:726 BROADWAY SUITE 347 I
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003
Mailing Address - Country:US
Mailing Address - Phone:212-443-1189
Mailing Address - Fax:212-443-1196
Practice Address - Street 1:726 BROADWAY SUITE 347 I
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003
Practice Address - Country:US
Practice Address - Phone:212-443-1189
Practice Address - Fax:212-443-1196
Is Sole Proprietor?:No
Enumeration Date:2018-11-27
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY487398-1163WC1400X
NY306679363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WC1400XNursing Service ProvidersRegistered NurseCollege Health