Provider Demographics
NPI:1174253652
Name:OLIVE BRANCH HEALTH CARE SERVICES PLLC
Entity Type:Organization
Organization Name:OLIVE BRANCH HEALTH CARE SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:M
Authorized Official - Last Name:MEITLER
Authorized Official - Suffix:
Authorized Official - Credentials:AGPCNP-C
Authorized Official - Phone:517-410-8347
Mailing Address - Street 1:9458 LOOKOUT POINT DR
Mailing Address - Street 2:
Mailing Address - City:LAINGSBURG
Mailing Address - State:MI
Mailing Address - Zip Code:48848-8783
Mailing Address - Country:US
Mailing Address - Phone:517-410-8347
Mailing Address - Fax:
Practice Address - Street 1:6160 SW HIGHWAY 200 STE 110-513
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34476-8307
Practice Address - Country:US
Practice Address - Phone:260-226-7848
Practice Address - Fax:260-233-6054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-16
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty