Provider Demographics
NPI:1639830599
Name:OLIVER, MICHELLE LYNN (RN)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:LYNN
Last Name:OLIVER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:LYNN
Other - Last Name:COLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7053 WEST BLVD
Mailing Address - Street 2:APT 67
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-4312
Mailing Address - Country:US
Mailing Address - Phone:330-371-8137
Mailing Address - Fax:
Practice Address - Street 1:7053 WEST BLVD
Practice Address - Street 2:APT 67
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-4312
Practice Address - Country:US
Practice Address - Phone:330-371-8137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-04
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN463729163W00000X, 163WC0400X, 163WC1500X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No163WC0400XNursing Service ProvidersRegistered NurseCase ManagementGroup - Multi-Specialty
No163WC1500XNursing Service ProvidersRegistered NurseCommunity HealthGroup - Multi-Specialty