Provider Demographics
NPI:1013774033
Name:OLIVIERI, MELODIE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:MELODIE
Middle Name:
Last Name:OLIVIERI
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2282 CRIMSON KING DR
Mailing Address - Street 2:
Mailing Address - City:BRASELTON
Mailing Address - State:GA
Mailing Address - Zip Code:30517-4098
Mailing Address - Country:US
Mailing Address - Phone:404-783-7191
Mailing Address - Fax:
Practice Address - Street 1:748 OLD NORCROSS RD STE 185
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-3395
Practice Address - Country:US
Practice Address - Phone:770-277-8554
Practice Address - Fax:404-494-7496
Is Sole Proprietor?:No
Enumeration Date:2024-03-05
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN160006363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily