Provider Demographics
NPI:1649607607
Name:SHALAUROVA, OLGA (FNP-BC)
Entity type:Individual
Prefix:
First Name:OLGA
Middle Name:
Last Name:SHALAUROVA
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 CHAPEL VALLEY LN
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-4676
Mailing Address - Country:US
Mailing Address - Phone:919-889-8569
Mailing Address - Fax:
Practice Address - Street 1:1831 LAKE PINE DR STE 200
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-6050
Practice Address - Country:US
Practice Address - Phone:919-889-8569
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-03
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5006530363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5006530OtherNC FNP LICENSE NUMBER
NC1649607607Medicaid