Provider Demographics
NPI:1205649589
Name:RAETZ, OLIVIA MARIE (PA)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:MARIE
Last Name:RAETZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:10 BLACKBURN KNL
Mailing Address - Street 2:
Mailing Address - City:SPENCERPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14559-2199
Mailing Address - Country:US
Mailing Address - Phone:585-471-9214
Mailing Address - Fax:
Practice Address - Street 1:1445 PORTLAND AVE STE 309
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-3008
Practice Address - Country:US
Practice Address - Phone:585-342-2638
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-30
Last Update Date:2025-01-30
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant