Provider Demographics
NPI:1003879222
Name:OLIVERA, CORINNE FAYE (PA-C)
Entity Type:Individual
Prefix:
First Name:CORINNE
Middle Name:FAYE
Last Name:OLIVERA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 220176
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99522-0176
Mailing Address - Country:US
Mailing Address - Phone:907-248-5818
Mailing Address - Fax:
Practice Address - Street 1:5005 RASPBERRY RD
Practice Address - Street 2:BUILDING 9
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99502-1982
Practice Address - Country:US
Practice Address - Phone:907-249-1276
Practice Address - Fax:907-249-1145
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK407363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical