Provider Demographics
NPI:1720617475
Name:JEW, OLIVIA SIMONE
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:SIMONE
Last Name:JEW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 FAIRMONT ST
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-8980
Mailing Address - Country:US
Mailing Address - Phone:415-608-0153
Mailing Address - Fax:
Practice Address - Street 1:410 MARKET ST STE 400
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27516-4061
Practice Address - Country:US
Practice Address - Phone:984-974-3900
Practice Address - Fax:984-974-3692
Is Sole Proprietor?:No
Enumeration Date:2020-04-05
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program