Active NPI
Olga Dekhtiareva, CRNP ADULT
- Adult Health Nurse Practitioner
- Rockville, MD
National Provider Identifier
1336377498
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adult Health Nurse Practitioner
- License
- R180041
- Practice address
- 15825 Shady Grove Rd
140
Rockville, MD 20850-4008 - Phone
- (301) 869-9776
- Fax
- (301) 216-2592
- NPI assigned
- Jun 29, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Health Nurse Practitioner | 363LA2200X | R180041 | MD | Primary |
Addresses
Primary practice location
15825 Shady Grove Rd
140
Rockville, MD 20850-4008
Mailing address
15825 Shady Grove Rd
140
Rockville, MD 20850-4015
Phone (301) 869-9776
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R180041 | MD | MD | Adult Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Frederick Health Hospital Inc | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
dba Frederick Health Hospital
- General Acute Care Hospital
- Frederick, MD
- NPI 1538165527
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1246233600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1403654400000",
"number": "1336377498",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15825 SHADY GROVE RD",
"address_2": "140",
"city": "ROCKVILLE",
"state": "MD",
"postal_code": "208504015",
"telephone_number": "301-869-9776",
"fax_number": "301-216-2592"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15825 SHADY GROVE RD",
"address_2": "140",
"city": "ROCKVILLE",
"state": "MD",
"postal_code": "208504008",
"telephone_number": "301-869-9776",
"fax_number": "301-216-2592"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEKHTIAREVA",
"first_name": "OLGA",
"credential": "CRNP ADULT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-06-29",
"last_updated": "2014-06-25",
"status": "A"
},
"taxonomies": [
{
"code": "363LA2200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Adult Health",
"state": "MD",
"license": "R180041",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rockville, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.