Provider Demographics
NPI:1710424767
Name:OLIVER, JESSICA (RN)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:
Last Name:OLIVER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9084 EASTER LN
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19973-8531
Mailing Address - Country:US
Mailing Address - Phone:717-586-0559
Mailing Address - Fax:
Practice Address - Street 1:9084 EASTER LN
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:DE
Practice Address - Zip Code:19973-8531
Practice Address - Country:US
Practice Address - Phone:717-586-0559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-30
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL1-0048429163W00000X
PARN636118163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse