Provider Demographics
NPI:1023197704
Name:OLIVER, BEVERLY JOYCE
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:JOYCE
Last Name:OLIVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 N MADISON ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:IA
Mailing Address - Zip Code:52537-1271
Mailing Address - Country:US
Mailing Address - Phone:641-664-2145
Mailing Address - Fax:641-664-2176
Practice Address - Street 1:509 N MADISON ST
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:IA
Practice Address - Zip Code:52537-1271
Practice Address - Country:US
Practice Address - Phone:641-664-2145
Practice Address - Fax:641-664-2176
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MORN086454363LX0001X
IA066358363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOS55710Medicare UPIN