Basic Information
| Provider Information | |||||||||
| NPI: | 1831197680 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHERNYAK | ||||||||
| FirstName: | OLGA | ||||||||
| MiddleName: | ALEX | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1209 NW NORTH RIDGE DR STE B | ||||||||
| Address2: | ANESTHESIA SERVICES OF BLUE SPRINGS | ||||||||
| City: | BLUE SPRINGS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640156320 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8169888415 | ||||||||
| FaxNumber: | 8169888395 | ||||||||
| Practice Location | |||||||||
| Address1: | 201 NW R D MIZE RD | ||||||||
| Address2: | ST. MARY'S MEDICAL CENTER/ANESTHESIA SERVICES OF BLUE S | ||||||||
| City: | BLUE SPRINGS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640142513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8169888415 | ||||||||
| FaxNumber: | 8169888395 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2005 | ||||||||
| LastUpdateDate: | 03/31/2015 | ||||||||
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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 | 367500000X | 686439 | TX | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 367500000X | 2012020211 | MO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 1831197680 | 05 | MO | MEDICAID | 158460902 | 05 | TX | MEDICAID |