Provider Demographics
NPI:1285132225
Name:OLIVEIRA, RAUNE (ACNP)
Entity type:Individual
Prefix:
First Name:RAUNE
Middle Name:
Last Name:OLIVEIRA
Suffix:
Gender:M
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 WILSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75061-2911
Mailing Address - Country:US
Mailing Address - Phone:469-789-4204
Mailing Address - Fax:
Practice Address - Street 1:1305 AIRPORT FWY STE 103
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-6603
Practice Address - Country:US
Practice Address - Phone:469-320-1267
Practice Address - Fax:469-320-1267
Is Sole Proprietor?:No
Enumeration Date:2018-01-24
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP136068363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care