Doctor Name: | MRS. OLGA MAIQUE |
NPI Number: | 1598009334 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | APN |
License Number: | 5005951 |
Business Practice Address: | 1362 N Gateway Ave Rockwood, TN - 378544108 |
Business Phone Number: | 8653541220 |
Business Fax Number: | 8653540112 |
Mailing Address: | 10723 Meriwether Ln, KNOXVILLE |
State: | TN |
Postal Code: | 379345287 |
Phone Number: | 8653567271 |
Fax Number: | |
NPI Enumeration Date: | 11/17/2012 |
NPI Last Update Date: | 03/28/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 5005951 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | NC |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |