Provider Demographics
NPI:1710591482
Name:OLIVA, AUDRIANNA
Entity Type:Individual
Prefix:
First Name:AUDRIANNA
Middle Name:
Last Name:OLIVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AUDRIANNA
Other - Middle Name:
Other - Last Name:SAWTELLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10319 HEMPHILL CT
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-3430
Mailing Address - Country:US
Mailing Address - Phone:757-771-8880
Mailing Address - Fax:
Practice Address - Street 1:10319 HEMPHILL CT
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-3430
Practice Address - Country:US
Practice Address - Phone:757-771-8880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-01
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95191501163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse