MEDICARE: CHARLES OLLERO

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	363LA2200X	Adult Health Nurse Practitioner	9423	CT

General Provider Information

NPI Number	:	1780271387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES OLLERO

Provider Business Mailing Address
First Line	:	1091 GUERNSEYTOWN RD
Second Line	:
City	:	WATERTOWN
State	:	CT
Zip	:	06795-1247
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	15 N MAIN ST STE 100
Second Line	:
City	:	WEST HARTFORD
State	:	CT
Zip	:	06107-1957
Country	:	US
Telephone Number	:	860-417-9156
Fax Number	:

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

Provider Enumeration Date	:	12/29/2020
Last Update Date	:	09/25/2024

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Directions to “ CHARLES OLLERO ” Practice Location

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