Provider Demographics
NPI:1578108320
Name:HARPER, OLIVIA BREANNA (CNM, FNP)
Entity Type:Individual
Prefix:MS
First Name:OLIVIA
Middle Name:BREANNA
Last Name:HARPER
Suffix:
Gender:F
Credentials:CNM, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14630 INDIANA ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48238-1771
Mailing Address - Country:US
Mailing Address - Phone:313-282-0500
Mailing Address - Fax:
Practice Address - Street 1:14648 INDIANA ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48238-1771
Practice Address - Country:US
Practice Address - Phone:313-333-6928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-14
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704397757367A00000X
OH0019576367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife