Provider Demographics
NPI:1396297826
Name:OLIVER, MARY ANN
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ANN
Last Name:OLIVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:OK
Mailing Address - Zip Code:73058-0005
Mailing Address - Country:US
Mailing Address - Phone:405-260-3441
Mailing Address - Fax:405-260-3442
Practice Address - Street 1:2403 S DIVISION, SUITE C&D
Practice Address - Street 2:
Practice Address - City:GUTHRIE
Practice Address - State:OKLAHOMA
Practice Address - Zip Code:73044
Practice Address - Country:UM
Practice Address - Phone:405-260-3441
Practice Address - Fax:405-260-3442
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-01
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management