Provider Demographics
NPI:1336377498
Name:DEKHTIAREVA, OLGA (CRNP ADULT)
Entity Type:Individual
Prefix:
First Name:OLGA
Middle Name:
Last Name:DEKHTIAREVA
Suffix:
Gender:F
Credentials:CRNP ADULT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15825 SHADY GROVE RD
Mailing Address - Street 2:140
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-4015
Mailing Address - Country:US
Mailing Address - Phone:301-869-9776
Mailing Address - Fax:301-216-2592
Practice Address - Street 1:15825 SHADY GROVE RD
Practice Address - Street 2:140
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-4008
Practice Address - Country:US
Practice Address - Phone:301-869-9776
Practice Address - Fax:301-216-2592
Is Sole Proprietor?:No
Enumeration Date:2009-06-29
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR180041363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health