Basic Information
Provider Information
NPI: 1003141896
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: OLIVIERI
FirstName: MARIA
MiddleName: MERCEDES
NamePrefix:  
NameSuffix:  
Credential: CD(DONA)
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 7027 VEERING LN
Address2:  
City: BURKE
State: VA
PostalCode: 220154445
CountryCode: US
TelephoneNumber: 7034554828
FaxNumber:  
Practice Location
Address1: 7027 VEERING LN
Address2:  
City: BURKE
State: VA
PostalCode: 220154445
CountryCode: US
TelephoneNumber: 7034554828
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/12/2009
LastUpdateDate: 10/12/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
374J00000X  Y Nursing Service Related ProvidersDoula 

No ID Information.


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