Provider Demographics
NPI:1780114736
Name:LAIDLEY, OLIVIA (APRN, RN)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:LAIDLEY
Suffix:
Gender:F
Credentials:APRN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 BLUE ELDERBERRY RUN
Mailing Address - Street 2:
Mailing Address - City:MONCKS CORNER
Mailing Address - State:SC
Mailing Address - Zip Code:29461-2908
Mailing Address - Country:US
Mailing Address - Phone:914-282-4190
Mailing Address - Fax:
Practice Address - Street 1:8595 PELHAM RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-5759
Practice Address - Country:US
Practice Address - Phone:864-316-8984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-13
Last Update Date:2024-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY729679163W00000X
NY353419363LF0000X
SC5428634363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01420795Medicaid