Provider Demographics
NPI:1427245968
Name:REYES OLIVA, NELIDA CARIDAD (PA-C)
Entity type:Individual
Prefix:MRS
First Name:NELIDA
Middle Name:CARIDAD
Last Name:REYES OLIVA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6040 MERIDIAN DR
Mailing Address - Street 2:APT 45
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68504-4404
Mailing Address - Country:US
Mailing Address - Phone:315-528-2415
Mailing Address - Fax:
Practice Address - Street 1:1411 SUPERIOR STREET
Practice Address - Street 2:MINUTE CLINIC INSIDE CVS PHARMACY
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68504
Practice Address - Country:US
Practice Address - Phone:188-838-9272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-28
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1338363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant