Provider Demographics
NPI:1871928713
Name:OLIVARES, GLORIA LARIOS (FNP)
Entity type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:LARIOS
Last Name:OLIVARES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:GLORIA
Other - Last Name:ORELLANA LARIOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2104 MARYLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-5612
Mailing Address - Country:US
Mailing Address - Phone:410-730-0821
Mailing Address - Fax:
Practice Address - Street 1:405 FREDERICK RD
Practice Address - Street 2:SUITE 11
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-4645
Practice Address - Country:US
Practice Address - Phone:410-788-4411
Practice Address - Fax:410-788-4545
Is Sole Proprietor?:No
Enumeration Date:2013-09-11
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR176239363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily