Doctor Name: | CORINNE FAYE OLIVERA |
NPI Number: | 1003879222 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PA-C |
License Number: | 407 |
Business Practice Address: | 5005 Raspberry Rd Building 9 Anchorage, AK - 995021982 |
Business Phone Number: | 9072491276 |
Business Fax Number: | 9072491145 |
Mailing Address: | Po Box 220176, ANCHORAGE |
State: | AK |
Postal Code: | 995220176 |
Phone Number: | 9072485818 |
Fax Number: | |
NPI Enumeration Date: | 04/10/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | 407 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AK |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |