Healthcare Provider Details

I. General information

NPI: 1730236084
Provider Name (Legal Business Name): OLGA NILOVA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 11/29/2023
Certification Date: 11/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 HYANNIS DR
HOLLY SPRINGS NC
27540-8327
US

IV. Provider business mailing address

106 HYANNIS DR
HOLLY SPRINGS NC
27540-8327
US

V. Phone/Fax

Practice location:
  • Phone: 919-249-4700
  • Fax: 919-249-4701
Mailing address:
  • Phone: 919-249-4700
  • Fax: 919-249-4701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number200601114
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: