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Individual
MARY E. OLIVA
Active
Individual
MARY E. OLIVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.-C,
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA636
KY
363AM0700X
Medical Physician Assistant
PA636
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
37903705
MEDICAID LAB GROUP
KY
01
—
4000501
MEDICARE LAB GROUP
KY
05
—
95001541
—
KY
01
—
CB5773
RR MEDICARE GROUP
—
Enumeration date
09/13/2006
Last updated
11/02/2007
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