Provider Demographics
NPI:1649827825
Name:POLUEKTOV, OLENA
Entity type:Individual
Prefix:
First Name:OLENA
Middle Name:
Last Name:POLUEKTOV
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 1:7959 COVERT LN
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-2757
Mailing Address - Country:US
Mailing Address - Phone:707-829-3540
Mailing Address - Fax:
Practice Address - Street 1:7959 COVERT LN
Practice Address - Street 2:
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-2757
Practice Address - Country:US
Practice Address - Phone:707-829-3540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-21
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider