Basic Information
| Provider Information | |||||||||
| NPI: | 1598282907 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OLIVER | ||||||||
| FirstName: | LUCY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 218 WANETAH DR | ||||||||
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| City: | MIDLAND | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486402997 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1900 COLUMBUS AVE | ||||||||
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| City: | BAY CITY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 487086831 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9898943000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/25/2017 | ||||||||
| LastUpdateDate: | 08/25/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 4704328559 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.