Provider Demographics
NPI:1457960304
Name:DE OLIVEIRA, LORIAN CANDACE (AGACNP-BC)
Entity Type:Individual
Prefix:
First Name:LORIAN
Middle Name:CANDACE
Last Name:DE OLIVEIRA
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:MS
Other - First Name:LORIAN
Other - Middle Name:CANDACE
Other - Last Name:JENKINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CNP
Mailing Address - Street 1:330 BROOKLINE AVE
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-5400
Mailing Address - Country:US
Mailing Address - Phone:917-796-3392
Mailing Address - Fax:
Practice Address - Street 1:16 WYOMING ST UNIT 2
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02121-1205
Practice Address - Country:US
Practice Address - Phone:917-796-3392
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-27
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2291496363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care