Provider Demographics
NPI:1407824253
Name:OLIVERA, C. YOLANDA (CRNA)
Entity Type:Individual
Prefix:
First Name:C.
Middle Name:YOLANDA
Last Name:OLIVERA
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1491 MONTREAL RD
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-6922
Mailing Address - Country:US
Mailing Address - Phone:770-270-1284
Mailing Address - Fax:
Practice Address - Street 1:1536 OAK GROVE RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-1728
Practice Address - Country:US
Practice Address - Phone:404-634-6411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN018254367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA43BBBWCMedicare ID - Type Unspecified
GAS18284Medicare UPIN