Provider Demographics
NPI:1194334094
Name:HASSELFELD, OLIVIA FAETH (PA)
Entity type:Individual
Prefix:MS
First Name:OLIVIA
Middle Name:FAETH
Last Name:HASSELFELD
Suffix:
Gender:
Credentials:PA
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Mailing Address - Street 1:PO BOX 7412011
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-2011
Mailing Address - Country:US
Mailing Address - Phone:800-647-2098
Mailing Address - Fax:314-362-3192
Practice Address - Street 1:2 PROGRESS POINT PKWY
Practice Address - Street 2:DIV IM MEDICAL ONCOLOGY
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-2205
Practice Address - Country:US
Practice Address - Phone:800-647-2098
Practice Address - Fax:314-362-3192
Is Sole Proprietor?:No
Enumeration Date:2020-07-27
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2020026369363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO220117552Medicaid