Provider Demographics
NPI:1730129628
Name:BROWN, OLIVIA ANNETTE (CRNA)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:ANNETTE
Last Name:BROWN
Suffix:
Gender:F
Credentials:CRNA
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:355 CRAWFORD STREET
Mailing Address - Street 2:SUITE 808
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23704
Mailing Address - Country:US
Mailing Address - Phone:757-399-7451
Mailing Address - Fax:757-399-1158
Practice Address - Street 1:3636 HIGH STREET
Practice Address - Street 2:MARYVIEW MEDICAL CENTER
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23707
Practice Address - Country:US
Practice Address - Phone:757-399-7451
Practice Address - Fax:757-399-1158
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2020-07-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0001120134367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010082293Medicaid