Individual
OLEG VIKTOR MIRONCHENKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DNP, APRN, PMHNP-BC
Contact information
Practice address
3320 PETERSON RD STE 104, LAWRENCE, KS 66049-1739
(785) 371-1414
(785) 371-4519
Mailing address
3320 PETERSON RD STE 104, LAWRENCE, KS 66049-1739
(785) 371-1414
(785) 371-4519
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
2024016173
MO
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
5382879021
KS
Other
Enumeration date
02/13/2025
Last updated
11/03/2025
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