Provider Demographics
NPI:1073037404
Name:WELNA, OLIVIA ALINA (PA-C)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:ALINA
Last Name:WELNA
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 1:409 JOYCE KILMER AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-3363
Mailing Address - Country:US
Mailing Address - Phone:732-418-0709
Mailing Address - Fax:732-317-3064
Practice Address - Street 1:409 JOYCE KILMER AVE UNIT 210
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-3363
Practice Address - Country:US
Practice Address - Phone:732-418-0709
Practice Address - Fax:732-317-3064
Is Sole Proprietor?:No
Enumeration Date:2017-07-27
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00436200363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ14433880OtherCAQH ID