Provider Demographics
NPI:1942571724
Name:AGUILAR, OLIVIA MARIE (PA)
Entity Type:Individual
Prefix:MS
First Name:OLIVIA
Middle Name:MARIE
Last Name:AGUILAR
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1471 EAST 84 TH PLACE
Mailing Address - Street 2:
Mailing Address - City:MERRILLIVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410
Mailing Address - Country:US
Mailing Address - Phone:219-769-8630
Mailing Address - Fax:219-769-8633
Practice Address - Street 1:1471 E 84TH PL
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-6451
Practice Address - Country:US
Practice Address - Phone:219-769-8630
Practice Address - Fax:219-769-8633
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-25
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0000000000363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN0000000000OtherDONT HAVE ONE