Provider Demographics
NPI:1851940589
Name:COMMON, OLIVIA
Entity Type:Individual
Prefix:MRS
First Name:OLIVIA
Middle Name:
Last Name:COMMON
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 1:651 RUE SAINT MICHAEL
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70056-8224
Mailing Address - Country:US
Mailing Address - Phone:504-400-2066
Mailing Address - Fax:
Practice Address - Street 1:651 RUE SAINT MICHAEL
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70056-8224
Practice Address - Country:US
Practice Address - Phone:504-400-2066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-05
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No172V00000XOther Service ProvidersCommunity Health Worker