Provider Demographics
NPI:1154065670
Name:TISCKOS, OLIVIA N
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:N
Last Name:TISCKOS
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 1:239 YEOMAN DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-5246
Mailing Address - Country:US
Mailing Address - Phone:217-971-0937
Mailing Address - Fax:
Practice Address - Street 1:239 YEOMAN DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-5246
Practice Address - Country:US
Practice Address - Phone:217-971-0937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-21
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program