Basic Information
| Provider Information | |||||||||
| NPI: | 1336377498 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEKHTIAREVA | ||||||||
| FirstName: | OLGA | ||||||||
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| Credential: | CRNP ADULT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15825 SHADY GROVE RD | ||||||||
| Address2: | 140 | ||||||||
| City: | ROCKVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208504015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3018699776 | ||||||||
| FaxNumber: | 3012162592 | ||||||||
| Practice Location | |||||||||
| Address1: | 15825 SHADY GROVE RD | ||||||||
| Address2: | 140 | ||||||||
| City: | ROCKVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208504008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3018699776 | ||||||||
| FaxNumber: | 3012162592 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2009 | ||||||||
| LastUpdateDate: | 06/25/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | R180041 | MD | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.