Healthcare Provider Details

I. General information

NPI: 1982407110
Provider Name (Legal Business Name): OLIVIA RAE OGLE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2025
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 N BRAINARD ST
NAPERVILLE IL
60540-4690
US

IV. Provider business mailing address

30 N BRAINARD ST
NAPERVILLE IL
60540-4607
US

V. Phone/Fax

Practice location:
  • Phone: 630-637-5100
  • Fax:
Mailing address:
  • Phone: 630-637-5100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085.011205
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: