Provider Demographics
NPI:1861478927
Name:OLIVEROS, AMORMIO M (CRNA)
Entity Type:Individual
Prefix:
First Name:AMORMIO
Middle Name:M
Last Name:OLIVEROS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2690 SOUTHFIELD DRIVE
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-4510
Mailing Address - Country:US
Mailing Address - Phone:717-741-1414
Mailing Address - Fax:717-741-4774
Practice Address - Street 1:2690 SOUTHFIELD DRIVE
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-4510
Practice Address - Country:US
Practice Address - Phone:717-741-1414
Practice Address - Fax:717-741-4774
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN262858L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA254658OtherUNISON HEALTH PLAN
PA693254ZB1BOtherMEDICARE
PA33270OtherGEISINGER HEALTH PLAN
GAP00693224OtherRAILROAD MEDICARE
PA000693254OtherBLUE SHIELD
PA0015946900003OtherMEDICAID
R99170OtherMEDICARE UPIN
PA50081122OtherCAPITAL BLUECROSS