Provider Demographics
NPI:1962000653
Name:OLIVER, JORDYN ASHLIE (NP-C)
Entity Type:Individual
Prefix:
First Name:JORDYN
Middle Name:ASHLIE
Last Name:OLIVER
Suffix:
Gender:F
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 1:2609 S 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83605-6816
Mailing Address - Country:US
Mailing Address - Phone:208-454-2766
Mailing Address - Fax:
Practice Address - Street 1:2609 S 10TH AVE
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83605-6816
Practice Address - Country:US
Practice Address - Phone:208-454-2766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-14
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID57711363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily