Provider Demographics
NPI:1477381614
Name:OLIECH, NEPHAT AMON
Entity type:Individual
Prefix:
First Name:NEPHAT
Middle Name:AMON
Last Name:OLIECH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15123 STRAWBERRY LN
Mailing Address - Street 2:
Mailing Address - City:ADELANTO
Mailing Address - State:CA
Mailing Address - Zip Code:92301-6316
Mailing Address - Country:US
Mailing Address - Phone:760-844-8683
Mailing Address - Fax:
Practice Address - Street 1:15123 STRAWBERRY LN
Practice Address - Street 2:
Practice Address - City:ADELANTO
Practice Address - State:CA
Practice Address - Zip Code:92301-6316
Practice Address - Country:US
Practice Address - Phone:760-844-8683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAF07241069363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily