Healthcare Provider Details

I. General information

NPI: 1639715519
Provider Name (Legal Business Name): OLIVIA M MORIN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: OLIVIA M MAXELL NP

II. Dates (important events)

Enumeration Date: 11/26/2019
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MILL RD
FAIRHAVEN MA
02719-5252
US

IV. Provider business mailing address

200 MILL RD
FAIRHAVEN MA
02719-5252
US

V. Phone/Fax

Practice location:
  • Phone: 508-973-3200
  • Fax: 508-973-3215
Mailing address:
  • Phone: 508-973-2000
  • Fax: 508-973-2001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN02212
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN2363177
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: