Provider Demographics
NPI:1922650803
Name:OLIVER, ELLARRY D (NP)
Entity Type:Individual
Prefix:
First Name:ELLARRY
Middle Name:D
Last Name:OLIVER
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5 SEVERANCE CIR STE 505
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-1588
Mailing Address - Country:US
Mailing Address - Phone:216-291-5151
Mailing Address - Fax:216-291-4460
Practice Address - Street 1:5 SEVERANCE CIR STE 505
Practice Address - Street 2:
Practice Address - City:CLEVELAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44118-1588
Practice Address - Country:US
Practice Address - Phone:216-291-5151
Practice Address - Fax:216-291-4460
Is Sole Proprietor?:No
Enumeration Date:2019-07-11
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.029397363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily