Provider Demographics
NPI:1649071242
Name:PETERO-HAAS, OLIVIA MICHELLE (RN)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:MICHELLE
Last Name:PETERO-HAAS
Suffix:
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 PARK HILL DR
Mailing Address - Street 2:
Mailing Address - City:SELDEN
Mailing Address - State:NY
Mailing Address - Zip Code:11784-2608
Mailing Address - Country:US
Mailing Address - Phone:631-459-9525
Mailing Address - Fax:
Practice Address - Street 1:22 PARK HILL DR
Practice Address - Street 2:
Practice Address - City:SELDEN
Practice Address - State:NY
Practice Address - Zip Code:11784-2608
Practice Address - Country:US
Practice Address - Phone:631-459-9525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-20
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY980745163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse