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General NPI Number Information
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NPI Number | 1972141034
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Entity Type | Individual
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Provider Name | OLIVIA DESENA
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Gender | Female
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Dates
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Enumeration Date | 12/19/2019
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Last Update Date | 04/29/2021
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Provider Practice Location Address
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Address Line | 26 W COLE RD STE 102
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City | BIDDEFORD
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State | ME
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Zip | 04005-9407
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Country | US
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Telephone | 207-756-0790
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Fax |
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Provider Business Mailing Address
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Address Line | 4 IVIE RD
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City | CAPE ELIZABETH
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State | ME
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Zip | 04107-1714
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Country | US
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Telephone | 207-756-0790
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | RN65220
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | CNP211084
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License Number State | ME
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