Provider Demographics
NPI:1205571213
Name:OLIVER, HEATHER LYNNETTE (RTR)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:LYNNETTE
Last Name:OLIVER
Suffix:
Gender:F
Credentials:RTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2521 278TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:IA
Mailing Address - Zip Code:52645-9199
Mailing Address - Country:US
Mailing Address - Phone:319-931-7529
Mailing Address - Fax:
Practice Address - Street 1:2521 278TH ST
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:IA
Practice Address - Zip Code:52645-9199
Practice Address - Country:US
Practice Address - Phone:319-931-7529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-03
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA100686156F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist