Provider Demographics
NPI:1336463389
Name:OLIVER, KRISTINA (LMT)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:OLIVER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14505 NE 20TH AVE APT 61
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98686-1490
Mailing Address - Country:US
Mailing Address - Phone:360-907-3648
Mailing Address - Fax:
Practice Address - Street 1:311 W EVERGREEN BLVD
Practice Address - Street 2:STE. #100
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98660-3371
Practice Address - Country:US
Practice Address - Phone:360-907-3648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-19
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR15838225700000X
374J00000X
WAMA60555361225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No374J00000XNursing Service Related ProvidersDoula