Healthcare Provider Details

I. General information

NPI: 1992680243
Provider Name (Legal Business Name): OLYMPIA CHAGOURIS ROSS MSN, ACM, WCCM, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2025
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32550 DOCS PL UNIT 2
MILLVILLE DE
19967-6975
US

IV. Provider business mailing address

27 W MC CABE ST
SELBYVILLE DE
19975-9316
US

V. Phone/Fax

Practice location:
  • Phone: 302-539-4302
  • Fax:
Mailing address:
  • Phone: 410-215-8002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberL1-0073482
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberL1-0073482
License Number StateDE
# 3
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberL1-0073482
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: