Healthcare Provider Details

I. General information

NPI: 1497317457
Provider Name (Legal Business Name): OLIVIA J CROSS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: OLIVIA J GREER PA-C

II. Dates (important events)

Enumeration Date: 06/30/2019
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 MEMBERS WAY FL 5
DOVER NH
03820-5933
US

IV. Provider business mailing address

PO BOX 412503
BOSTON MA
02241-2503
US

V. Phone/Fax

Practice location:
  • Phone: 603-609-6800
  • Fax:
Mailing address:
  • Phone: 603-609-6800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2026
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2847
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: