Provider Demographics
NPI:1548741879
Name:CAUDLE, OLIVIA XIMENIA (LVN)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:XIMENIA
Last Name:CAUDLE
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 1:4305 COLLEGE MAIN ST APT 16
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77801-4054
Mailing Address - Country:US
Mailing Address - Phone:304-417-1650
Mailing Address - Fax:
Practice Address - Street 1:4305 COLLEGE MAIN ST APT 16
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77801-4054
Practice Address - Country:US
Practice Address - Phone:304-417-1650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-24
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX344016164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse