Provider Demographics
NPI:1821446915
Name:OLIVER, JESSE (NP-C)
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:
Last Name:OLIVER
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 LEBEC ROAD
Mailing Address - Street 2:
Mailing Address - City:LEBEC
Mailing Address - State:CA
Mailing Address - Zip Code:93243
Mailing Address - Country:US
Mailing Address - Phone:661-248-5250
Mailing Address - Fax:661-248-5279
Practice Address - Street 1:704 LEBEC ROAD
Practice Address - Street 2:
Practice Address - City:LEBEC
Practice Address - State:CA
Practice Address - Zip Code:93243
Practice Address - Country:US
Practice Address - Phone:661-248-5279
Practice Address - Fax:661-248-5279
Is Sole Proprietor?:No
Enumeration Date:2016-05-30
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95004380363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily