Provider Demographics
NPI:1134120751
Name:OLIVER, BRANT J (NP, MSN, CS, APRN-BC)
Entity Type:Individual
Prefix:
First Name:BRANT
Middle Name:J
Last Name:OLIVER
Suffix:
Gender:M
Credentials:NP, MSN, CS, APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:246 PLEASANT STREET MEMORIAL BUILDING, WEST, GROUND FLO
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-2588
Mailing Address - Country:US
Mailing Address - Phone:603-224-6691
Mailing Address - Fax:603-228-7087
Practice Address - Street 1:246 PLEASANT STREET MEMORIAL BUILDING, WEST, GROUND FLO
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-2588
Practice Address - Country:US
Practice Address - Phone:603-224-6691
Practice Address - Fax:603-228-7087
Is Sole Proprietor?:No
Enumeration Date:2005-08-04
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH053117-23-03363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1010718Medicaid
NH30343057Medicaid
NH30343057Medicaid