Provider Demographics
NPI:1881482412
Name:HISCOX, OLIVIA MICHELLE
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:MICHELLE
Last Name:HISCOX
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 1:11942 DEVONSHIRE AVE
Mailing Address - Street 2:
Mailing Address - City:DES PERES
Mailing Address - State:MO
Mailing Address - Zip Code:63131-4509
Mailing Address - Country:US
Mailing Address - Phone:314-471-7251
Mailing Address - Fax:
Practice Address - Street 1:11942 DEVONSHIRE AVE
Practice Address - Street 2:
Practice Address - City:DES PERES
Practice Address - State:MO
Practice Address - Zip Code:63131-4509
Practice Address - Country:US
Practice Address - Phone:314-471-7251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-25
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty