Provider Demographics
NPI:1346893419
Name:OLIVER, RICHARA (LPN)
Entity Type:Individual
Prefix:
First Name:RICHARA
Middle Name:
Last Name:OLIVER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 W WENGER RD APT 9
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45322-1926
Mailing Address - Country:US
Mailing Address - Phone:937-279-7603
Mailing Address - Fax:
Practice Address - Street 1:601 W WENGER RD APT 9
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:OH
Practice Address - Zip Code:45322-1926
Practice Address - Country:US
Practice Address - Phone:937-279-7603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-18
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH16865.MEDS.IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse