Provider Demographics
NPI:1447744958
Name:BLAGOVERNYY, OLGA (RN)
Entity type:Individual
Prefix:
First Name:OLGA
Middle Name:
Last Name:BLAGOVERNYY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 BATTLE GREEN DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14624-4969
Mailing Address - Country:US
Mailing Address - Phone:585-236-0478
Mailing Address - Fax:
Practice Address - Street 1:131 BATTLE GREEN DR
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14624-4969
Practice Address - Country:US
Practice Address - Phone:585-236-0478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-18
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY739293163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse