Provider Demographics
NPI:1265484307
Name:OLIVER, LYNETTE I (MD)
Entity Type:Individual
Prefix:DR
First Name:LYNETTE
Middle Name:I
Last Name:OLIVER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3205 AVE ISLA VERDE
Mailing Address - Street 2:GALAXY CONDOMINIUM APT. 802
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00979-4924
Mailing Address - Country:US
Mailing Address - Phone:787-268-7632
Mailing Address - Fax:787-268-7632
Practice Address - Street 1:3205 AVE ISLA VERDE
Practice Address - Street 2:GALAXY CONDOMINIUM APT. 802
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00979-4924
Practice Address - Country:US
Practice Address - Phone:787-268-7632
Practice Address - Fax:787-268-7632
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY137613207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY137613OtherNEW YORK LICENSE
CT038377OtherCT LICENSE
ME015199OtherME LICENSE
PR6404OtherLICENCE
PR6404OtherLICENCE