Active NPI
Marla M Olish, PNP
- Pediatric Nurse Practitioner
- Grover, MO
National Provider Identifier
1215020078
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Nurse Practitioner
- License
- 61038
- Practice address
- 16555 Manchester Rd
Suite 100
Grover, MO 63040-1220 - Phone
- (636) 458-5858
- NPI assigned
- Oct 2, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Nurse Practitioner | 363LP0200X | 61038 | MO | Primary |
Addresses
Primary practice location
16555 Manchester Rd
Suite 100
Grover, MO 63040-1220
Mailing address
2201 White Elm CT
Chesterfield, MO 63017-7282
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 61038 | MO | MD | Pediatric Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159747200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1215020078",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2201 WHITE ELM CT",
"city": "CHESTERFIELD",
"state": "MO",
"postal_code": "630177282"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16555 MANCHESTER RD",
"address_2": "SUITE 100",
"city": "GROVER",
"state": "MO",
"postal_code": "630401220",
"telephone_number": "636-458-5858"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OLISH",
"first_name": "MARLA",
"middle_name": "M",
"credential": "PNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-02",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363LP0200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Pediatrics",
"state": "MO",
"license": "61038",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grover, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.