Provider Demographics
NPI:1023088333
Name:OLIVER, LAURA L (PA-C)
Entity type:Individual
Prefix:MISS
First Name:LAURA
Middle Name:L
Last Name:OLIVER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1941 LIMESTONE RD
Mailing Address - Street 2:STE 101
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-5408
Mailing Address - Country:US
Mailing Address - Phone:302-633-3555
Mailing Address - Fax:302-633-3559
Practice Address - Street 1:3401 BRANDYWINE PKWY
Practice Address - Street 2:STE 101
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-1554
Practice Address - Country:US
Practice Address - Phone:302-633-3555
Practice Address - Fax:302-479-1559
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DEC5-0000188363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
DES98007Medicare UPIN
DE388972ZC2LMedicare PIN