Provider Demographics
NPI:1497219505
Name:ALEXANDRESCU, OLIMPIA RAMONA
Entity Type:Individual
Prefix:
First Name:OLIMPIA
Middle Name:RAMONA
Last Name:ALEXANDRESCU
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 1:1020 W ORCHARD AVE
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83651-1877
Mailing Address - Country:US
Mailing Address - Phone:208-606-9336
Mailing Address - Fax:208-936-3021
Practice Address - Street 1:1020 W ORCHARD AVE
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-1877
Practice Address - Country:US
Practice Address - Phone:208-606-9336
Practice Address - Fax:208-936-3021
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-23
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID65542278H0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2278H0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDA0003233Medicaid