Provider Demographics
NPI:1710725775
Name:MAYORAS, OLIVIA GEEHAE
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:GEEHAE
Last Name:MAYORAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25664 PENINSULA DR
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48374-2164
Mailing Address - Country:US
Mailing Address - Phone:248-915-8531
Mailing Address - Fax:
Practice Address - Street 1:25664 PENINSULA DR
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48374-2164
Practice Address - Country:US
Practice Address - Phone:248-915-8531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-16
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704417675163WP0218X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0218XNursing Service ProvidersRegistered NursePediatric Oncology