Provider Demographics
NPI:1457523524
Name:OLIPHANT, JOSHUA B (LMP)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:B
Last Name:OLIPHANT
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 S 7TH ST
Mailing Address - Street 2:APT. D
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98274-3982
Mailing Address - Country:US
Mailing Address - Phone:360-333-0114
Mailing Address - Fax:
Practice Address - Street 1:102 S 7TH ST
Practice Address - Street 2:APT. D
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98274-3982
Practice Address - Country:US
Practice Address - Phone:360-333-0114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-29
Last Update Date:2008-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00025221174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist