Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 30.026358 | OH |
Y | 204E00000X | Oral & Maxillofacial Surgeon | 35.141381 | OH |
NPI | 1013460658 |
---|---|
Provider Name | Petra Olivieri |
First Address | Cleveland, OH 44109-1900 |
Second Address | Cleveland, OH 44109-1900 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2016 |
Last Update Date | 27/12/2021 |