Provider Demographics
NPI:1386497709
Name:HIDDEMEN, OLIVIA ALVERDA JEANETTE (PA-C)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:ALVERDA JEANETTE
Last Name:HIDDEMEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:OLIVIA
Other - Middle Name:
Other - Last Name:HIDDEMEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2204 KINGSRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-2712
Mailing Address - Country:US
Mailing Address - Phone:302-494-2821
Mailing Address - Fax:
Practice Address - Street 1:4755 OGLETOWN STANTON RD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19718-2200
Practice Address - Country:US
Practice Address - Phone:302-733-2410
Practice Address - Fax:302-733-2602
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-08
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC5-0012106363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant