Provider Demographics
NPI:1245782895
Name:LANDIS, OLIVIA ROSE (RN)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:ROSE
Last Name:LANDIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 GREENBROOK DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NJ
Mailing Address - Zip Code:08022-2319
Mailing Address - Country:US
Mailing Address - Phone:609-970-3427
Mailing Address - Fax:
Practice Address - Street 1:33 GREENBROOK DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NJ
Practice Address - Zip Code:08022-2319
Practice Address - Country:US
Practice Address - Phone:609-970-3427
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-31
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR18115600163W00000X
PARN678287163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse