Provider Demographics
NPI:1083014971
Name:OLAVARRIA, COURTNEY (RN)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:OLAVARRIA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8260 WICKER AVE
Mailing Address - Street 2:LAKE CENTRAL SCHOOL CORPORATION
Mailing Address - City:SAINT JOHN
Mailing Address - State:IN
Mailing Address - Zip Code:46373
Mailing Address - Country:US
Mailing Address - Phone:219-365-8507
Mailing Address - Fax:
Practice Address - Street 1:8915 WEST 93RD AVENUE
Practice Address - Street 2:CLARK MIDDLE SCHOOL
Practice Address - City:SAINT JOHN
Practice Address - State:IN
Practice Address - Zip Code:46373
Practice Address - Country:US
Practice Address - Phone:219-365-9203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-27
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28170763A163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool