Provider Demographics
NPI:1053101295
Name:HYPPOLITE, OLGUEN
Entity type:Individual
Prefix:
First Name:OLGUEN
Middle Name:
Last Name:HYPPOLITE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 CENTENNIAL DR
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-7939
Mailing Address - Country:US
Mailing Address - Phone:781-539-4566
Mailing Address - Fax:
Practice Address - Street 1:9 CENTENNIAL DR
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-7939
Practice Address - Country:US
Practice Address - Phone:781-539-4566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-10
Last Update Date:2025-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9639169163W00000X
MARN9639169163WC0400X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC0400XNursing Service ProvidersRegistered NurseCase ManagementGroup - Multi-Specialty