Provider Demographics
NPI:1366038770
Name:DELAVEGA, OLIVIA DIANNE (MSN, CNM)
Entity Type:Individual
Prefix:MRS
First Name:OLIVIA
Middle Name:DIANNE
Last Name:DELAVEGA
Suffix:
Gender:F
Credentials:MSN, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 SUMMIT CIR
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75032-8962
Mailing Address - Country:US
Mailing Address - Phone:214-460-6575
Mailing Address - Fax:
Practice Address - Street 1:506 SUMMIT CIR
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-8962
Practice Address - Country:US
Practice Address - Phone:214-460-6575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-19
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1021158176B00000X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No176B00000XOther Service ProvidersMidwife