Provider Demographics
NPI:1235629601
Name:OLIVA, CRYSTAL (LVN)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:OLIVA
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:885 KEENELAND CT
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75211-6987
Mailing Address - Country:US
Mailing Address - Phone:214-755-1151
Mailing Address - Fax:
Practice Address - Street 1:885 KEENELAND CT
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75211-6987
Practice Address - Country:US
Practice Address - Phone:214-755-1151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-11
Last Update Date:2018-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX337089164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse