Provider Demographics
NPI:1356836902
Name:OLIVER, DEMETRA MARCIA
Entity Type:Individual
Prefix:MRS
First Name:DEMETRA
Middle Name:MARCIA
Last Name:OLIVER
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 1:2125 FOREST EDGE DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27406-5429
Mailing Address - Country:US
Mailing Address - Phone:336-457-8668
Mailing Address - Fax:
Practice Address - Street 1:2125 FOREST EDGE DR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27406-5429
Practice Address - Country:US
Practice Address - Phone:336-457-8668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-26
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0OtherN/A