Provider Demographics
NPI:1811072309
Name:OLENCHAK, STEVEN L (PA)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:L
Last Name:OLENCHAK
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1399 GALLERIA DR
Mailing Address - Street 2:203
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-6662
Mailing Address - Country:US
Mailing Address - Phone:702-951-7238
Mailing Address - Fax:702-413-7240
Practice Address - Street 1:1399 GALLERIA DR
Practice Address - Street 2:203
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-6662
Practice Address - Country:US
Practice Address - Phone:702-951-7238
Practice Address - Fax:702-413-7240
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2011-10-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NVPA688363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002402500Medicaid
NVP88212Medicare UPIN
NVV37510Medicare PIN