Provider Demographics
NPI:1083081608
Name:DEBREE, OLIVIA (NP)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:DEBREE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:OLIVIA
Other - Middle Name:
Other - Last Name:DE BREE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:3075 ADELINE STREET, SUITE 280
Mailing Address - Street 2:LIFELONG MEDICAL CARE, ASHBY HEALTH CENTER
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94703
Mailing Address - Country:US
Mailing Address - Phone:510-981-4100
Mailing Address - Fax:
Practice Address - Street 1:3075 ADELINE STREET, SUITE 280
Practice Address - Street 2:LIFELONG MEDICAL CARE, ASHBY HEALTH CENTER
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94703
Practice Address - Country:US
Practice Address - Phone:510-981-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-31
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95002949363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health