Provider Demographics
NPI:1205641073
Name:OLIVER, EZIAKU JENNIFER (DR)
Entity type:Individual
Prefix:
First Name:EZIAKU
Middle Name:JENNIFER
Last Name:OLIVER
Suffix:
Gender:F
Credentials:DR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7308 FOREST BEND DR
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:TX
Mailing Address - Zip Code:75002-6817
Mailing Address - Country:US
Mailing Address - Phone:972-922-4510
Mailing Address - Fax:972-442-0113
Practice Address - Street 1:7308 FOREST BEND DR
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:TX
Practice Address - Zip Code:75002-6817
Practice Address - Country:US
Practice Address - Phone:972-922-4510
Practice Address - Fax:972-442-0113
Is Sole Proprietor?:No
Enumeration Date:2025-02-10
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP140033363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily