Provider Demographics
NPI:1740772698
Name:CHATHAM, OLIVIA KEALANI ROBINSON (NP)
Entity Type:Individual
Prefix:MRS
First Name:OLIVIA
Middle Name:KEALANI ROBINSON
Last Name:CHATHAM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7620 STALMER ST UNIT 103
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-4862
Mailing Address - Country:US
Mailing Address - Phone:619-301-2874
Mailing Address - Fax:
Practice Address - Street 1:950 CIVIC CENTER DR # A
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-5208
Practice Address - Country:US
Practice Address - Phone:760-439-4839
Practice Address - Fax:760-650-0098
Is Sole Proprietor?:No
Enumeration Date:2018-06-05
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95009164363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily