MEDICARE: CORINNE FAYE OLIVERA PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	407	AK

General Provider Information

NPI Number	:	1003879222
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CORINNE FAYE OLIVERA PA-C

Provider Business Mailing Address
First Line	:	PO BOX 220176
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99522-0176
Country	:	US
Telephone Number	:	907-248-5818
Fax Number	:

Provider Business Practice Location Address
First Line	:	5005 RASPBERRY RD
Second Line	:	BUILDING 9
City	:	ANCHORAGE
State	:	AK
Zip	:	99502-1982
Country	:	US
Telephone Number	:	907-249-1276
Fax Number	:	907-249-1145

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/10/2006
Last Update Date	:	07/08/2007

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