Provider Demographics
NPI:1336504018
Name:OLIVER, STEPHANIE (NP-C)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:OLIVER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 N ELM ST
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-3011
Mailing Address - Country:US
Mailing Address - Phone:910-671-5367
Mailing Address - Fax:910-738-3764
Practice Address - Street 1:302 MOUNT TABOR RD
Practice Address - Street 2:SUITE A
Practice Address - City:RED SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:28377-6415
Practice Address - Country:US
Practice Address - Phone:910-843-9991
Practice Address - Fax:910-843-9995
Is Sole Proprietor?:No
Enumeration Date:2015-12-22
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5008267363L00000X
NC239635363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily