Provider Demographics
NPI:1114322401
Name:OLENICK, GINA
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:OLENICK
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 1:2411 CROFTON LN
Mailing Address - Street 2:SUITE 17A
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114-1304
Mailing Address - Country:US
Mailing Address - Phone:410-721-5742
Mailing Address - Fax:
Practice Address - Street 1:2411 CROFTON LN
Practice Address - Street 2:SUITE 17A
Practice Address - City:CROFTON
Practice Address - State:MD
Practice Address - Zip Code:21114-1304
Practice Address - Country:US
Practice Address - Phone:410-721-5742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-29
Last Update Date:2015-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02189171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist