Provider Demographics
NPI:1477901775
Name:DIMMIG, OLIVIA (RN)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:DIMMIG
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:OLIVIA
Other - Middle Name:
Other - Last Name:MAST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:601 WESTTOWN RD
Mailing Address - Street 2:SUITE 180
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382-4958
Mailing Address - Country:US
Mailing Address - Phone:610-344-6459
Mailing Address - Fax:610-344-6727
Practice Address - Street 1:601 WESTTOWN RD
Practice Address - Street 2:SUITE 180
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19382-4958
Practice Address - Country:US
Practice Address - Phone:610-344-6459
Practice Address - Fax:610-344-6727
Is Sole Proprietor?:No
Enumeration Date:2016-05-26
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN678949163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse