Provider Demographics
NPI:1114563574
Name:OLIVO, ALEXANDRA
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:OLIVO
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 1:25 BRAINTREE HILL OFFICE PARK STE 101
Mailing Address - Street 2:
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184-8715
Mailing Address - Country:US
Mailing Address - Phone:781-971-5019
Mailing Address - Fax:
Practice Address - Street 1:237 HAMPSHIRE ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-1306
Practice Address - Country:US
Practice Address - Phone:617-575-5570
Practice Address - Fax:617-876-0217
Is Sole Proprietor?:No
Enumeration Date:2019-11-20
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2319744163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse