Provider Demographics
NPI:1053139766
Name:TIKHONOV, OLGA (RN, IBCLC, MPH)
Entity type:Individual
Prefix:
First Name:OLGA
Middle Name:
Last Name:TIKHONOV
Suffix:
Gender:F
Credentials:RN, IBCLC, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 N WILLOW ST APT 1
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-3502
Mailing Address - Country:US
Mailing Address - Phone:201-925-5276
Mailing Address - Fax:
Practice Address - Street 1:48 N WILLOW ST APT 1
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-3502
Practice Address - Country:US
Practice Address - Phone:201-925-5276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-01
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJL-141081163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant