Basic Information
| Provider Information | |||||||||
| NPI: | 1528655446 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OLIVARES | ||||||||
| FirstName: | JANET | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 619 S PORT ST | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212243648 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5717488349 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2401 W BELVEDERE AVE | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212155270 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106019000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/26/2020 | ||||||||
| LastUpdateDate: | 02/17/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN1056862 | DC | N | Nursing Service Providers | Registered Nurse | 163W00000X | R204257 | MD | N | Nursing Service Providers | Registered Nurse | 367500000X | R204257 | MD | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | R204257 | 01 | MD | MARYLAND BOARD OF NURSING | OTHER | RN1056862 | 01 | DC | DISTRICT OF COLUMBIA BOARD OF NURSING | OTHER |