Provider Demographics
NPI:1700287893
Name:MURTHY, OLENA KUSHNARENKO (CNP)
Entity Type:Individual
Prefix:
First Name:OLENA
Middle Name:KUSHNARENKO
Last Name:MURTHY
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:178 SAVIN ST
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-2329
Mailing Address - Country:US
Mailing Address - Phone:781-338-7400
Mailing Address - Fax:781-338-7405
Practice Address - Street 1:178 SAVIN ST
Practice Address - Street 2:
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-2329
Practice Address - Country:US
Practice Address - Phone:781-338-7400
Practice Address - Fax:781-338-7405
Is Sole Proprietor?:No
Enumeration Date:2014-09-09
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2263841363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily