Provider Demographics
NPI:1578043006
Name:OLIVER, ELAINA ELIZABETH
Entity Type:Individual
Prefix:
First Name:ELAINA
Middle Name:ELIZABETH
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 1:3832 ANDERSEN LN
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:WY
Mailing Address - Zip Code:83014-9194
Mailing Address - Country:US
Mailing Address - Phone:307-413-7770
Mailing Address - Fax:
Practice Address - Street 1:3832 ANDERSEN LN
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:WY
Practice Address - Zip Code:83014-9194
Practice Address - Country:US
Practice Address - Phone:307-413-7770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-15
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services