Healthcare Provider Details

I. General information

NPI: 1629811765
Provider Name (Legal Business Name): DENITZE OLVERA CHW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

2001 N JEFFERSON AVE
MOUNT PLEASANT TX
75455-2338
US

IV. Provider business mailing address

2001 N JEFFERSON AVE
MOUNT PLEASANT TX
75455-2338
US

V. Phone/Fax

Practice location:
  • Phone: 903-577-6000
  • Fax: 903-577-6245
Mailing address:
  • Phone: 903-577-6000
  • Fax: 903-577-6245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License NumberNONE
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: