Provider Demographics
NPI:1699508762
Name:KLENERT, OLIVIA LAUREN (NP)
Entity type:Individual
Prefix:MS
First Name:OLIVIA
Middle Name:LAUREN
Last Name:KLENERT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 STORY ST APT 2
Mailing Address - Street 2:
Mailing Address - City:SOUTH BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02127-3772
Mailing Address - Country:US
Mailing Address - Phone:508-944-3367
Mailing Address - Fax:
Practice Address - Street 1:25 STORY ST APT 2
Practice Address - Street 2:
Practice Address - City:SOUTH BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02127-3772
Practice Address - Country:US
Practice Address - Phone:508-944-3367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-23
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2302372363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care