Provider Demographics
NPI:1437742798
Name:MBA, OLIVIER (CRNA)
Entity Type:Individual
Prefix:DR
First Name:OLIVIER
Middle Name:
Last Name:MBA
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3869 BRENTVIEW PL NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-2292
Mailing Address - Country:US
Mailing Address - Phone:678-333-1944
Mailing Address - Fax:
Practice Address - Street 1:3869 BRENTVIEW PL NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-2292
Practice Address - Country:US
Practice Address - Phone:678-333-1944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-18
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN195909367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered