Provider Demographics
NPI:1144913369
Name:RODRIGUEZ OLVERA, DEISY (APRN)
Entity type:Individual
Prefix:
First Name:DEISY
Middle Name:
Last Name:RODRIGUEZ OLVERA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3602 AVENUE OF THE CITIES
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-4421
Mailing Address - Country:US
Mailing Address - Phone:309-743-1470
Mailing Address - Fax:309-743-1472
Practice Address - Street 1:3602 AVENUE OF THE CITIES
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-4421
Practice Address - Country:US
Practice Address - Phone:309-732-1470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-01
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA173541363L00000X
IL209.027408363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner