Provider Demographics
NPI:1063989945
Name:HALVORSON, OLIVIA K (APRN)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:K
Last Name:HALVORSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 PEACH TREE RD
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-3646
Mailing Address - Country:US
Mailing Address - Phone:865-712-1582
Mailing Address - Fax:
Practice Address - Street 1:175 CAPITAL BLVD STE 402458
Practice Address - Street 2:
Practice Address - City:ROCKY HILL
Practice Address - State:CT
Practice Address - Zip Code:06067-3914
Practice Address - Country:US
Practice Address - Phone:860-421-9172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-29
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT187076163W00000X
CT10384363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse