Healthcare Provider Details

I. General information

NPI: 1952858623
Provider Name (Legal Business Name): TERESA OLIVERI RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2016
Last Update Date: 09/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

670 9TH ST SUITE 203
ARCATA CA
95521-6248
US

IV. Provider business mailing address

3306 RENNER DR
FORTUNA CA
95540-3120
US

V. Phone/Fax

Practice location:
  • Phone: 707-826-8633
  • Fax: 707-826-8628
Mailing address:
  • Phone: 707-725-6101
  • Fax: 707-725-2978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95103325
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: