Healthcare Provider Details

I. General information

NPI: 1902526619
Provider Name (Legal Business Name): ANDREA OLVERA-NAVA LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2022
Last Update Date: 09/01/2022
Certification Date: 09/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2521 N ELMS RD
FLUSHING MI
48433-9423
US

IV. Provider business mailing address

2521 N ELMS RD
FLUSHING MI
48433-9423
US

V. Phone/Fax

Practice location:
  • Phone: 866-498-3909
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number4703123751
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number4703123751
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: