Provider Demographics
NPI:1356993596
Name:OLLER-LAUREANO, NAIROBI (CNP)
Entity type:Individual
Prefix:
First Name:NAIROBI
Middle Name:
Last Name:OLLER-LAUREANO
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:NAIROBI
Other - Middle Name:
Other - Last Name:OLLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10 GOVE ST
Mailing Address - Street 2:
Mailing Address - City:EAST BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02128-1931
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10 GOVE ST
Practice Address - Street 2:
Practice Address - City:EAST BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02128-1931
Practice Address - Country:US
Practice Address - Phone:617-568-6333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-09
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2291769163W00000X
MARN2291769207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No163W00000XNursing Service ProvidersRegistered Nurse