MEDICARE: C. YOLANDA OLIVERA CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	RN018254	GA

General Provider Information

NPI Number	:	1407824253
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	C. YOLANDA OLIVERA CRNA

Provider Business Mailing Address
First Line	:	1491 MONTREAL RD
Second Line	:
City	:	TUCKER
State	:	GA
Zip	:	30084-6922
Country	:	US
Telephone Number	:	770-270-1284
Fax Number	:

Provider Business Practice Location Address
First Line	:	1536 OAK GROVE RD
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30033-1728
Country	:	US
Telephone Number	:	404-634-6411
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/09/2006
Last Update Date	:	07/08/2007

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Directions to “ C. YOLANDA OLIVERA CRNA” Practice Location

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