Provider Demographics
NPI:1548873433
Name:CLELLAND, OLIVIA MUSTIN (PA)
Entity type:Individual
Prefix:MRS
First Name:OLIVIA
Middle Name:MUSTIN
Last Name:CLELLAND
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MISS
Other - First Name:OLIVIA
Other - Middle Name:RUTH
Other - Last Name:MUSTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:301 E WENDOVER AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-1232
Mailing Address - Country:US
Mailing Address - Phone:336-274-3241
Mailing Address - Fax:336-272-7134
Practice Address - Street 1:301 E WENDOVER AVE STE 200
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1232
Practice Address - Country:US
Practice Address - Phone:336-274-3241
Practice Address - Fax:336-272-7134
Is Sole Proprietor?:No
Enumeration Date:2020-08-28
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant