=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154973113
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JILL MARIE OLES FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/10/2019
-----------------------------------------------------
Last Update Date | 06/05/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 301 RIVERVIEW AVE STE 400
-----------------------------------------------------
City | NORFOLK
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23510-1065
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-622-5325
-----------------------------------------------------
Fax | 757-625-0501
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2520 SHIPS WATCH CT
-----------------------------------------------------
City | VIRGINIA BEACH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23451-1267
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-560-7001
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 0024176959
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------