Provider Demographics
NPI:1598358434
Name:OLAGUE, WILLIAM RANDOLPH
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:RANDOLPH
Last Name:OLAGUE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3708 LAKESIDE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-5371
Mailing Address - Country:US
Mailing Address - Phone:775-826-8090
Mailing Address - Fax:775-826-9008
Practice Address - Street 1:3708 LAKESIDE DR STE 200
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-5371
Practice Address - Country:US
Practice Address - Phone:775-826-8090
Practice Address - Fax:775-826-9008
Is Sole Proprietor?:No
Enumeration Date:2021-02-11
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant