Provider Demographics
NPI:1962496471
Name:HATHAWAY, OLANDA MARIE (FAMILY NURSE PRACTIT)
Entity Type:Individual
Prefix:MRS
First Name:OLANDA
Middle Name:MARIE
Last Name:HATHAWAY
Suffix:
Gender:F
Credentials:FAMILY NURSE PRACTIT
Other - Prefix:
Other - First Name:LONDA
Other - Middle Name:MARIE
Other - Last Name:HATHAWAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSN
Mailing Address - Street 1:10 CENTER DRIVE
Mailing Address - Street 2:BUILDING 10 ROOM 13C413
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20892
Mailing Address - Country:US
Mailing Address - Phone:301-402-7454
Mailing Address - Fax:
Practice Address - Street 1:10 CENTER DRIVE
Practice Address - Street 2:BUILDING 10 ROOM 13C413
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20892
Practice Address - Country:US
Practice Address - Phone:301-402-7454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN042630363LF0000X
MDR109289363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD082NL614Medicare PIN