Provider Demographics
NPI:1104792290
Name:NAMYALO, OLIVER (APRN)
Entity type:Individual
Prefix:
First Name:OLIVER
Middle Name:
Last Name:NAMYALO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 GIANT TRL
Mailing Address - Street 2:
Mailing Address - City:SEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44273-8980
Mailing Address - Country:US
Mailing Address - Phone:216-213-8855
Mailing Address - Fax:
Practice Address - Street 1:511 GIANT TRL
Practice Address - Street 2:
Practice Address - City:SEVILLE
Practice Address - State:OH
Practice Address - Zip Code:44273-8980
Practice Address - Country:US
Practice Address - Phone:216-213-8855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-15
Last Update Date:2025-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLE-00059901363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily