Provider Demographics
NPI:1124389804
Name:OLIVER, MICHELLE AVIVA (RN APN)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:AVIVA
Last Name:OLIVER
Suffix:
Gender:F
Credentials:RN APN
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:261 JAMES ST
Mailing Address - Street 2:SUITE 2G
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-6392
Mailing Address - Country:US
Mailing Address - Phone:973-267-6400
Mailing Address - Fax:973-267-7295
Practice Address - Street 1:261 JAMES ST
Practice Address - Street 2:SUITE 2G
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-6392
Practice Address - Country:US
Practice Address - Phone:973-267-6400
Practice Address - Fax:973-267-7295
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-30
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00380000363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty