Provider Demographics
NPI:1326569450
Name:OLIVO, ANNA (NP-C)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:OLIVO
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 CLARK ST
Mailing Address - Street 2:
Mailing Address - City:ROCHDALE
Mailing Address - State:MA
Mailing Address - Zip Code:01542-1139
Mailing Address - Country:US
Mailing Address - Phone:508-221-7314
Mailing Address - Fax:
Practice Address - Street 1:366 SHREWSBURY ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01604-4647
Practice Address - Country:US
Practice Address - Phone:508-595-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-28
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2281279363LF0000X
CT8091363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily