Provider Demographics
NPI:1871388512
Name:OGANESYAN, ELLEN (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:OGANESYAN
Suffix:
Gender:
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:718 E OLIVE AVE APT D
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91501-2135
Mailing Address - Country:US
Mailing Address - Phone:818-425-3154
Mailing Address - Fax:
Practice Address - Street 1:718 E OLIVE AVE APT D
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91501-2135
Practice Address - Country:US
Practice Address - Phone:818-425-3154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-14
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95034589363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner