Provider Demographics
NPI:1841329992
Name:OLIVAS, ELENA A (CNP)
Entity type:Individual
Prefix:
First Name:ELENA
Middle Name:A
Last Name:OLIVAS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 734
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:NM
Mailing Address - Zip Code:88048-0734
Mailing Address - Country:US
Mailing Address - Phone:505-635-7336
Mailing Address - Fax:
Practice Address - Street 1:865 N MAIN
Practice Address - Street 2:
Practice Address - City:ANTHONY
Practice Address - State:NM
Practice Address - Zip Code:88021-9325
Practice Address - Country:US
Practice Address - Phone:505-882-7552
Practice Address - Fax:505-882-3063
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR28404363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health