Provider Demographics
NPI:1235170564
Name:OLIVER, CAROL (NP)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:
Last Name:OLIVER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5389
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:OR
Mailing Address - Zip Code:97415-0107
Mailing Address - Country:US
Mailing Address - Phone:541-412-8700
Mailing Address - Fax:
Practice Address - Street 1:413 MILL BEACH RD
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:OR
Practice Address - Zip Code:97415-9690
Practice Address - Country:US
Practice Address - Phone:541-412-8700
Practice Address - Fax:707-465-6166
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200650010NP FNP-PP363LF0000X
CANPF9514363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA271907Medicare PIN
Q25127Medicare UPIN