MEDICARE: OLIVIA MARIE GAUSE 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	363A00000X	Physician Assistant	0010-11385	NC
2	363AM0700X	Medical Physician Assistant	0010-11385	NC

General Provider Information

NPI Number	:	1104441922
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLIVIA MARIE GAUSE PA-C

Provider Business Mailing Address
First Line	:	1755 8TH STREET DR NE APT D
Second Line	:
City	:	HICKORY
State	:	NC
Zip	:	28601-2341
Country	:	US
Telephone Number	:	919-771-4547
Fax Number	:

Provider Business Practice Location Address
First Line	:	2920 FORESTVILLE RD STE 100
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27616-8774
Country	:	US
Telephone Number	:	860-882-7525
Fax Number	:

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

Provider Enumeration Date	:	06/08/2020
Last Update Date	:	12/01/2025

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