Provider Demographics
NPI:1164179586
Name:ROTERMUND, OLGA JANE (NURSE)
Entity Type:Individual
Prefix:
First Name:OLGA
Middle Name:JANE
Last Name:ROTERMUND
Suffix:
Gender:F
Credentials:NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 DOVER DR
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-3322
Mailing Address - Country:US
Mailing Address - Phone:925-787-4110
Mailing Address - Fax:
Practice Address - Street 1:210 DOVER DR
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-3322
Practice Address - Country:US
Practice Address - Phone:925-787-4110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-05
Last Update Date:2022-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG3944207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology