Provider Demographics
NPI:1689247512
Name:NIMLEY, OLIVIA BEDELL
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:BEDELL
Last Name:NIMLEY
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 1:4705 TWISTED OAKS RD APT 205
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28212-7316
Mailing Address - Country:US
Mailing Address - Phone:704-248-1289
Mailing Address - Fax:
Practice Address - Street 1:4705 TWISTED OAKS RD APT 205
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28212-7316
Practice Address - Country:US
Practice Address - Phone:704-248-1289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other