Healthcare Provider Details

I. General information

NPI: 1932923083
Provider Name (Legal Business Name): OLIVIA SHEA BATSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2024
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VIA GIORGIO CORBETTA, 17
VICNEZA VICENZA
36100
IT

IV. Provider business mailing address

8225 ADENLEE AVE APT 10
FAIRFAX VA
22031-4825
US

V. Phone/Fax

Practice location:
  • Phone: 44-461-9000
  • Fax:
Mailing address:
  • Phone: 831-444-5712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number0402208503
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: