Healthcare Provider Details

I. General information

NPI: 1780318634
Provider Name (Legal Business Name): LAURA MARIE OLVERA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2022
Last Update Date: 07/14/2022
Certification Date: 07/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 6TH ST
RAYMOND WA
98577-2503
US

IV. Provider business mailing address

4741 PLOVER ST NE
OLYMPIA WA
98516-4531
US

V. Phone/Fax

Practice location:
  • Phone: 360-280-4414
  • Fax:
Mailing address:
  • Phone: 619-493-7386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number46-1009805
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: