Provider Demographics
NPI:1336289321
Name:OLIVER, SUSAN (ANP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:OLIVER
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7441 FOXRIDGE WAY
Mailing Address - Street 2:# H
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99518-2756
Mailing Address - Country:US
Mailing Address - Phone:503-910-4080
Mailing Address - Fax:
Practice Address - Street 1:3760 PIPER STREET
Practice Address - Street 2:SUITE 1087
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504
Practice Address - Country:US
Practice Address - Phone:907-212-6284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK953363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care