Healthcare Provider Details

I. General information

NPI: 1174316897
Provider Name (Legal Business Name): OLIVIA OFFERMANN
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2025
Last Update Date: 05/26/2025
Certification Date: 05/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1802 BRAEBURN DR
SALEM VA
24153-7357
US

IV. Provider business mailing address

2630 STANLEY AVE SE
ROANOKE VA
24014-3334
US

V. Phone/Fax

Practice location:
  • Phone: 540-772-3530
  • Fax:
Mailing address:
  • Phone: 540-769-9216
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: