MEDICARE: DEEPA OLI FNP

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	363LF0000X	Family Nurse Practitioner	0024191442	VA

General Provider Information

NPI Number	:	1245050442
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEEPA OLI FNP

Provider Business Mailing Address
First Line	:	4504 GASTON ST
Second Line	:
City	:	CHANTILLY
State	:	VA
Zip	:	20151-2244
Country	:	US
Telephone Number	:	571-282-5380
Fax Number	:

Provider Business Practice Location Address
First Line	:	850 WALNUT BOTTOM RD STE 101B
Second Line	:
City	:	CARLISLE
State	:	PA
Zip	:	17013-3615
Country	:	US
Telephone Number	:	571-282-5380
Fax Number	:

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

Provider Enumeration Date	:	10/12/2024
Last Update Date	:	12/10/2025

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