Provider Demographics
NPI:1629404546
Name:OLIVER, MARY P
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:P
Last Name:OLIVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:E
Other - Last Name:POLLY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:431 DEADFALL ROAD WEST
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29646
Mailing Address - Country:US
Mailing Address - Phone:864-941-3429
Mailing Address - Fax:864-388-2418
Practice Address - Street 1:431 DEADFALL RD W
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29649-9546
Practice Address - Country:US
Practice Address - Phone:864-941-3429
Practice Address - Fax:864-388-2418
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-24
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC208182163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool