Healthcare Provider Details

I. General information

NPI: 1336782275
Provider Name (Legal Business Name): ALBERT BYRON OLIVERA MSN, APRN, FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2019
Last Update Date: 05/18/2020
Certification Date: 05/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

163 N MAIN ST
NORTH BROOKFIELD MA
01535-1400
US

IV. Provider business mailing address

163 N MAIN ST
NORTH BROOKFIELD MA
01535-1400
US

V. Phone/Fax

Practice location:
  • Phone: 508-637-1604
  • Fax: 508-637-1605
Mailing address:
  • Phone: 508-637-1604
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2303440
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: