Provider Demographics
NPI:1407543838
Name:WALDER, OLIVIA ANN (APRN)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:ANN
Last Name:WALDER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 N MELVIN ST
Mailing Address - Street 2:
Mailing Address - City:GIBSON CITY
Mailing Address - State:IL
Mailing Address - Zip Code:60936-1477
Mailing Address - Country:US
Mailing Address - Phone:217-784-4251
Mailing Address - Fax:
Practice Address - Street 1:912 W SEMINARY AVE
Practice Address - Street 2:
Practice Address - City:ONARGA
Practice Address - State:IL
Practice Address - Zip Code:60955-1401
Practice Address - Country:US
Practice Address - Phone:815-268-4840
Practice Address - Fax:815-268-4845
Is Sole Proprietor?:No
Enumeration Date:2023-04-18
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041454193163W00000X
IL209027194363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse