Provider Demographics
NPI:1306362959
Name:ALFRED, OLIVE
Entity Type:Individual
Prefix:
First Name:OLIVE
Middle Name:
Last Name:ALFRED
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 GLASSY LAKE DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BCH
Mailing Address - State:VA
Mailing Address - Zip Code:23453-7027
Mailing Address - Country:US
Mailing Address - Phone:757-281-8383
Mailing Address - Fax:
Practice Address - Street 1:1701 GLASSY LAKE DR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BCH
Practice Address - State:VA
Practice Address - Zip Code:23453-7027
Practice Address - Country:US
Practice Address - Phone:757-281-8383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver