Provider Demographics
NPI:1821537549
Name:OLIVERO, ANAIS (PA-C)
Entity Type:Individual
Prefix:
First Name:ANAIS
Middle Name:
Last Name:OLIVERO
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 1:817 E GANNON AVE
Mailing Address - Street 2:STE 104
Mailing Address - City:ZEBULON
Mailing Address - State:NC
Mailing Address - Zip Code:27597-9309
Mailing Address - Country:US
Mailing Address - Phone:919-375-1975
Mailing Address - Fax:
Practice Address - Street 1:817 E GANNON AVE
Practice Address - Street 2:
Practice Address - City:ZEBULON
Practice Address - State:NC
Practice Address - Zip Code:27597-9350
Practice Address - Country:US
Practice Address - Phone:919-375-1975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-14
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC001007062363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant