Provider Demographics
NPI:1891378733
Name:SLEZIK, OLIVIA ANNE (NP)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:ANNE
Last Name:SLEZIK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:486 CHANDLER ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01602-2861
Mailing Address - Country:US
Mailing Address - Phone:508-929-8875
Mailing Address - Fax:508-929-8075
Practice Address - Street 1:486 CHANDLER ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01602-2861
Practice Address - Country:US
Practice Address - Phone:508-929-8875
Practice Address - Fax:508-929-8075
Is Sole Proprietor?:No
Enumeration Date:2021-04-29
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2327857363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care