Provider Demographics
NPI:1053656587
Name:OLIVER, JANA MARIE (LMP)
Entity Type:Individual
Prefix:MS
First Name:JANA
Middle Name:MARIE
Last Name:OLIVER
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2977 NE LOYOLA ST
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98311-4013
Mailing Address - Country:US
Mailing Address - Phone:360-917-5262
Mailing Address - Fax:
Practice Address - Street 1:16521 13TH AVE W
Practice Address - Street 2:SUITE 108
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98037-8528
Practice Address - Country:US
Practice Address - Phone:360-917-5262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-10
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60322775225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist