Provider Demographics
NPI:1184683518
Name:OLVERA, RHONDA (APRN-BC)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:
Last Name:OLVERA
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1911 BUENA VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:MO
Mailing Address - Zip Code:64836-3178
Mailing Address - Country:US
Mailing Address - Phone:417-237-0983
Mailing Address - Fax:417-237-0983
Practice Address - Street 1:1911 BUENA VISTA AVE
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:MO
Practice Address - Zip Code:64836-3178
Practice Address - Country:US
Practice Address - Phone:417-237-0983
Practice Address - Fax:417-237-0983
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX696074363L00000X
MO087235363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXS58376Medicare UPIN