Provider Demographics
NPI:1740573757
Name:KONDRATYUK, OLGA
Entity type:Individual
Prefix:
First Name:OLGA
Middle Name:
Last Name:KONDRATYUK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1579 S LAKE CREST WAY
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-7141
Mailing Address - Country:US
Mailing Address - Phone:208-250-6583
Mailing Address - Fax:208-639-6298
Practice Address - Street 1:1579 S LAKE CREST WAY
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-7141
Practice Address - Country:US
Practice Address - Phone:208-250-6583
Practice Address - Fax:208-639-6298
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-24
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No171R00000XOther Service ProvidersInterpreter
No172A00000XOther Service ProvidersDriver
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion
No373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
No376K00000XNursing Service Related ProvidersNurse's Aide