Provider Demographics
NPI:1609295823
Name:OLIVER, KIM (RN BSN)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:OLIVER
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24765 CROCKER BLVD
Mailing Address - Street 2:
Mailing Address - City:HARRISON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48045-1905
Mailing Address - Country:US
Mailing Address - Phone:586-493-9753
Mailing Address - Fax:586-493-9754
Practice Address - Street 1:24765 CROCKER BLVD
Practice Address - Street 2:
Practice Address - City:HARRISON TWP
Practice Address - State:MI
Practice Address - Zip Code:48045-1905
Practice Address - Country:US
Practice Address - Phone:586-493-9753
Practice Address - Fax:586-493-9754
Is Sole Proprietor?:No
Enumeration Date:2014-04-15
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704193706163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4704193706OtherSTATE OF MICHIGAN DEPT OF LICENSING AND REGULATORY AFFAIRS BOARD OF NURSING