Provider Demographics
NPI:1548157688
Name:OLIVER, CORNELIA (LVN)
Entity type:Individual
Prefix:
First Name:CORNELIA
Middle Name:
Last Name:OLIVER
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15351 CABALLO RD
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92555-2905
Mailing Address - Country:US
Mailing Address - Phone:661-485-9419
Mailing Address - Fax:
Practice Address - Street 1:15351 CABALLO RD
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92555-2905
Practice Address - Country:US
Practice Address - Phone:661-485-9419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-20
Last Update Date:2025-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN730595164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse