Provider Demographics
NPI:1225679236
Name:OLIVER, QAADIR E
Entity Type:Individual
Prefix:
First Name:QAADIR
Middle Name:E
Last Name:OLIVER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 LEMANS DR APT 5
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-2035
Mailing Address - Country:US
Mailing Address - Phone:330-774-4640
Mailing Address - Fax:
Practice Address - Street 1:70 LEMANS DR APT 5
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-2035
Practice Address - Country:US
Practice Address - Phone:330-774-4640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-01
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0190622374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide