Olivia Jane Dizon, DNP
Individual provider Active NPI Family Nurse Practitioner · Queenstown, MD
NPI 1346096575 · NPPES record last updated Apr 29, 2024
Key facts
- NPI
- 1346096575
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- AC006253 (MD)
- Practice address
- 125 Shoreway Dr Ste 120
Queenstown, MD 21658-1681 - Phone
- (410) 827-4001
- NPI assigned
- Apr 29, 2024
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Hospital & facility affiliations 7
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2023
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Maryland Primary Care Physicians, LLC
Practice addresses (Care Compare)
125 Shoreway Dr
Suite 120
Queenstown, MD 21658-1681
Phone (410) 827-4001
Hospital & facility affiliations
- Vna of Maryland- Chestertown
- University of MD Shore Medical Center at Easton
- Luminis Health Anne Arundel Medical Center, Inc
- University of MD Shore Medical Ctr at Chestertown
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MD
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20241001003268 | MD | Practitioner - Nurse Practitioner | 3274064266 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AC006253 | MD | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Maryland Primary Care Physicians, LLC | Current |
Accepting new patients |
Locations
125 Shoreway Dr
Ste 120
Queenstown, MD 21658
Phone (410) 643-7800
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | AC006253 | MD | Yes |
Addresses
Primary practice location
125 Shoreway Dr Ste 120
Queenstown, MD 21658-1681
Mailing address
3 Perry Cir Apt F
Annapolis, MD 21402-1350
Other providers in Queenstown, MD
- Lauren Brien Bond
- Mary Neeley Boyce
- Melissa M. Brown
- Kevin Scott Cameron
- James Martin Chamberlain
- Elizabeth Dzwonczyk
- Emergency Medicine Associates, PA
- Jamie Lynne Harms
- Jean Jauregui
- Catherine Jeans
All providers in Queenstown, MD · Family Nurse Practitioner in Maryland
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 29, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.