Provider Demographics
NPI:1477382968
Name:OLIVE BRANCH WELLNESS CENTER
Entity type:Organization
Organization Name:OLIVE BRANCH WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADVANCED PRACTICE NURSE
Authorized Official - Prefix:MRS
Authorized Official - First Name:ATIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAMPTEY
Authorized Official - Suffix:
Authorized Official - Credentials:MSN AGNP-C APN
Authorized Official - Phone:732-593-9712
Mailing Address - Street 1:220 DAVIDSON AVE.
Mailing Address - Street 2:4TH FLOOR SUITE F
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873
Mailing Address - Country:US
Mailing Address - Phone:732-593-9712
Mailing Address - Fax:
Practice Address - Street 1:220 DAVIDSON AVE.
Practice Address - Street 2:4TH FLOOR SUITE F
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873
Practice Address - Country:US
Practice Address - Phone:732-593-9712
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-31
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty