Provider Demographics
NPI:1235281965
Name:OLIVER, ROBIN RENEE (RNC, WHNP)
Entity Type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:RENEE
Last Name:OLIVER
Suffix:
Gender:F
Credentials:RNC, WHNP
Other - Prefix:MRS
Other - First Name:ROBIN
Other - Middle Name:RENEE
Other - Last Name:BRATCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:5866 PARKMONT DR
Mailing Address - Street 2:
Mailing Address - City:IMPERIAL
Mailing Address - State:MO
Mailing Address - Zip Code:63052-2160
Mailing Address - Country:US
Mailing Address - Phone:636-467-5820
Mailing Address - Fax:
Practice Address - Street 1:3619 RICHARDSON SQUARE DR
Practice Address - Street 2:SUITE 140
Practice Address - City:ARNOLD
Practice Address - State:MO
Practice Address - Zip Code:63010-6022
Practice Address - Country:US
Practice Address - Phone:636-717-6780
Practice Address - Fax:314-525-1028
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO103266363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1235281965Medicaid
MOP01416349OtherRR MCR PTAN
MOMA5293002Medicare PIN
MOQ75860Medicare UPIN