Provider Demographics
NPI:1053040550
Name:NEGRETE, OLGA SERGEYEVNA
Entity Type:Individual
Prefix:
First Name:OLGA
Middle Name:SERGEYEVNA
Last Name:NEGRETE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8705 SKY VIEW DR
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-7939
Mailing Address - Country:US
Mailing Address - Phone:443-362-2579
Mailing Address - Fax:
Practice Address - Street 1:500 CADMUS LN
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-4094
Practice Address - Country:US
Practice Address - Phone:443-362-2579
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-09
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD201909363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner