Provider Demographics
NPI:1487201307
Name:OLVERA, LORA
Entity Type:Individual
Prefix:
First Name:LORA
Middle Name:
Last Name:OLVERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 DELAWARE ST
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32506-6430
Mailing Address - Country:US
Mailing Address - Phone:850-456-9609
Mailing Address - Fax:
Practice Address - Street 1:5 DELAWARE ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32506-6430
Practice Address - Country:US
Practice Address - Phone:850-456-9609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-26
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider