Provider Demographics
NPI:1912238775
Name:OLIVO, TERESA MARIE (CRNA)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:MARIE
Last Name:OLIVO
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 HOSPITAL PLZ
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:WV
Mailing Address - Zip Code:26354-1283
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:904-494-6467
Practice Address - Street 1:1 HOSPITAL PLZ
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:WV
Practice Address - Zip Code:26354-1283
Practice Address - Country:US
Practice Address - Phone:304-265-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-19
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV55751367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0207026000OtherMEDICAID GROUP
OH3019254OtherOHIO MEDICAID
WV3810016709Medicaid
WV9333201OtherMEDICARE GROUP
OH3019254OtherOHIO MEDICAID
OH3019254OtherOHIO MEDICAID