Healthcare Provider Details

I. General information

NPI: 1487344271
Provider Name (Legal Business Name): OLIVIA LEE ROVNAK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2023
Last Update Date: 05/15/2023
Certification Date: 05/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 LOTHROP ST
PITTSBURGH PA
15213-2536
US

IV. Provider business mailing address

4004 FOREST DR
ALIQUIPPA PA
15001-4700
US

V. Phone/Fax

Practice location:
  • Phone: 724-480-6551
  • Fax:
Mailing address:
  • Phone: 724-480-6551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA063903
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: