Provider Demographics
NPI:1164684924
Name:OLIVE, ROSEMARY JUDITH (RN, MSN, CNS)
Entity Type:Individual
Prefix:MS
First Name:ROSEMARY
Middle Name:JUDITH
Last Name:OLIVE
Suffix:
Gender:F
Credentials:RN, MSN, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6695
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-0695
Mailing Address - Country:US
Mailing Address - Phone:415-499-7682
Mailing Address - Fax:
Practice Address - Street 1:397 BRYCE CANYON RD
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-2226
Practice Address - Country:US
Practice Address - Phone:415-499-7682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-01
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN 338797163W00000X
CACNS 1972163WC1600X
CA1972364SC1501X, 364SP1700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP1700XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPerinatal
No163W00000XNursing Service ProvidersRegistered Nurse
No163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development
No364SC1501XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistCommunity Health/Public Health