Healthcare Provider Details

I. General information

NPI: 1962063651
Provider Name (Legal Business Name): CAROLINE A OLOO MSN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2019
Last Update Date: 06/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1554 JASON DR
CINNAMINSON NJ
08077-1558
US

IV. Provider business mailing address

1554 JASON DR
CINNAMINSON NJ
08077-1558
US

V. Phone/Fax

Practice location:
  • Phone: 512-731-5002
  • Fax:
Mailing address:
  • Phone: 512-731-5002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00928400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: