Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | AP126791 | TX |
Y | 363LP0200X | Nurse Practitioner - Pediatrics | AP126791 | TX |
NPI | 1023414380 |
---|---|
Provider Name | Jennifer Olivarez |
First Address | Corpus Christi, TX 78405-2010 |
Second Address | Corpus Christi, TX 78405-2010 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2014 |
Last Update Date | 12/12/2016 |