Healthcare Provider Details

I. General information

NPI: 1184683518
Provider Name (Legal Business Name): RHONDA OLVERA APRN-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 01/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 BUENA VISTA AVE
CARTHAGE MO
64836-3178
US

IV. Provider business mailing address

1911 BUENA VISTA AVE
CARTHAGE MO
64836-3178
US

V. Phone/Fax

Practice location:
  • Phone: 417-237-0983
  • Fax: 417-237-0983
Mailing address:
  • Phone: 417-237-0983
  • Fax: 417-237-0983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number696074
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number087235
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: