Provider Demographics
NPI:1922349489
Name:PLYUSHKO, SVETLANA A (BS)
Entity Type:Individual
Prefix:
First Name:SVETLANA
Middle Name:A
Last Name:PLYUSHKO
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7413 S HICKORY AVE
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74011-6046
Mailing Address - Country:US
Mailing Address - Phone:918-392-7875
Mailing Address - Fax:800-206-7966
Practice Address - Street 1:2448 E. 81ST STREET
Practice Address - Street 2:SUITE 5125
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-4213
Practice Address - Country:US
Practice Address - Phone:918-392-7875
Practice Address - Fax:800-260-7966
Is Sole Proprietor?:No
Enumeration Date:2013-03-08
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKTRAINING IN PROCESS225C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKNEW ENROLLMENTOtherOHCA (OKLAHOMA)