Healthcare Provider Details

I. General information

NPI: 1225242043
Provider Name (Legal Business Name): OLIMPIA ROSARIO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 08/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 PLEASANT GROVE RD.
JONESBORO AR
72404
US

IV. Provider business mailing address

1815 PLEASANT GROVE RD.
JONESBORO AR
72404
US

V. Phone/Fax

Practice location:
  • Phone: 870-933-6886
  • Fax:
Mailing address:
  • Phone: 870-933-6886
  • Fax: 870-933-9395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number0101230251
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: