Provider Demographics
NPI:1407872765
Name:OLIVETO, GINA (MD)
Entity Type:Individual
Prefix:DR
First Name:GINA
Middle Name:
Last Name:OLIVETO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:657 N 58TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68132-2001
Mailing Address - Country:US
Mailing Address - Phone:402-980-8499
Mailing Address - Fax:712-350-2325
Practice Address - Street 1:657 N 58TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68132-2001
Practice Address - Country:US
Practice Address - Phone:402-980-8499
Practice Address - Fax:712-350-2325
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.00698392084P0804X
IAMD-505692084P0804X
NY3200952084P0804X
NE226662084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME407770099Medicaid
MEME0587Medicare ID - Type Unspecified
ME407770099Medicaid