Provider Demographics
NPI:1417604190
Name:RUBESKI, OLIVIA LOUISE (PA-C)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:LOUISE
Last Name:RUBESKI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:247 HERITAGE CIR
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3017
Mailing Address - Country:US
Mailing Address - Phone:978-804-4014
Mailing Address - Fax:
Practice Address - Street 1:631 JOHNNIE DODDS BLVD
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3030
Practice Address - Country:US
Practice Address - Phone:843-881-0815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-03
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4314363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical