Basic Information
| Provider Information | |||||||||
| NPI: | 1780943258 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | OLIVER | ||||||||
| FirstName: | LIZ | ||||||||
| MiddleName: | V | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4204 GARDENDALE ST | ||||||||
| Address2: | STE 312 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782293132 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2102936006 | ||||||||
| FaxNumber: | 2106141722 | ||||||||
| Practice Location | |||||||||
| Address1: | 4204 GARDENDALE ST | ||||||||
| Address2: | STE 312 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782293132 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2102936006 | ||||||||
| FaxNumber: | 2106141722 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2012 | ||||||||
| LastUpdateDate: | 02/04/2015 | ||||||||
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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 | 363L00000X | AP121785 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.