Provider Demographics
NPI:1942733985
Name:SKLYARENKO, LYUDMILA G (ACNP)
Entity Type:Individual
Prefix:
First Name:LYUDMILA
Middle Name:G
Last Name:SKLYARENKO
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14320 SW 134TH DR
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-1745
Mailing Address - Country:US
Mailing Address - Phone:918-361-9341
Mailing Address - Fax:
Practice Address - Street 1:14320 SW 134TH DR
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97224-1745
Practice Address - Country:US
Practice Address - Phone:918-361-9341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-06
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201607763NP-PP364SA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2100XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAcute Care