Provider Demographics
NPI:1619605383
Name:MESEROLE, OLIVIA NORA (PA-C)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:NORA
Last Name:MESEROLE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 10TH ST
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77550-5113
Mailing Address - Country:US
Mailing Address - Phone:815-721-7856
Mailing Address - Fax:
Practice Address - Street 1:3166 S STATE HIGHWAY 161 STE 170
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-7720
Practice Address - Country:US
Practice Address - Phone:972-640-0005
Practice Address - Fax:210-314-5044
Is Sole Proprietor?:No
Enumeration Date:2022-08-10
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AM0700X
TXPA15938363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical