Provider Demographics
NPI:1285401067
Name:NOSARYEVA, OLENA (RN)
Entity type:Individual
Prefix:
First Name:OLENA
Middle Name:
Last Name:NOSARYEVA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2895 ANDERSON ST
Mailing Address - Street 2:
Mailing Address - City:WANTAGH
Mailing Address - State:NY
Mailing Address - Zip Code:11793-2327
Mailing Address - Country:US
Mailing Address - Phone:631-355-6502
Mailing Address - Fax:
Practice Address - Street 1:2895 ANDERSON ST
Practice Address - Street 2:
Practice Address - City:WANTAGH
Practice Address - State:NY
Practice Address - Zip Code:11793-2327
Practice Address - Country:US
Practice Address - Phone:631-355-6502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-11
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY655012163WR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0400XNursing Service ProvidersRegistered NurseRehabilitation