Healthcare Provider Details

I. General information

NPI: 1528789351
Provider Name (Legal Business Name): JENNIFER OLMO RN, BEC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

80 WOODLAND AVE, APT #2
KEARNY NJ
07032
US

IV. Provider business mailing address

80 WOODLAND AVE, APT #2
KEARNY NJ
07032
US

V. Phone/Fax

Practice location:
  • Phone: 646-283-4884
  • Fax:
Mailing address:
  • Phone: 646-283-4884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number26WR19491600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: