Provider Demographics
NPI:1881933729
Name:CASTRO, OLGA (CRNA)
Entity type:Individual
Prefix:
First Name:OLGA
Middle Name:
Last Name:CASTRO
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:OLGA
Other - Middle Name:
Other - Last Name:BOTVENKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:723 HADDON RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-4423
Mailing Address - Country:US
Mailing Address - Phone:302-765-7945
Mailing Address - Fax:
Practice Address - Street 1:1090 OLD CHURCHMANS RD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2102
Practice Address - Country:US
Practice Address - Phone:302-892-2710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-13
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN582211367500000X
DEL6-0A00652367500000X
DEL1-0034295163W00000X
NJ26NR13516000163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
91963OtherAANA #