Provider Demographics
NPI:1942510128
Name:OLIVER, MARISSA CAYLAN (LPN)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:CAYLAN
Last Name:OLIVER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:249 KENSINGTON PL
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-4428
Mailing Address - Country:US
Mailing Address - Phone:740-262-4533
Mailing Address - Fax:
Practice Address - Street 1:249 KENSINGTON PL
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-4428
Practice Address - Country:US
Practice Address - Phone:740-262-4533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-20
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH140273164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse