Provider Demographics
NPI:1477244002
Name:HAFER, OLIVIA NICHOLE (APRN-CNP)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:NICHOLE
Last Name:HAFER
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:MAYSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41056-1341
Mailing Address - Country:US
Mailing Address - Phone:606-301-1457
Mailing Address - Fax:
Practice Address - Street 1:212 POPLAR ST
Practice Address - Street 2:
Practice Address - City:MAYSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41056-1341
Practice Address - Country:US
Practice Address - Phone:606-301-1457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-16
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4002407363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner