Provider Demographics
NPI:1669042446
Name:OLVERA, EVANGELINEA
Entity Type:Individual
Prefix:
First Name:EVANGELINEA
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:PO BOX 631165
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77263-1165
Mailing Address - Country:US
Mailing Address - Phone:713-725-0985
Mailing Address - Fax:
Practice Address - Street 1:3411 JEANETTA ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77063-5541
Practice Address - Country:US
Practice Address - Phone:713-725-0985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-25
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX904043163W00000X
251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No163W00000XNursing Service ProvidersRegistered Nurse