Provider Demographics
NPI:1952546954
Name:OLIVER, MARY ANNE (APRN-BC, FNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ANNE
Last Name:OLIVER
Suffix:
Gender:F
Credentials:APRN-BC, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 PINNACLE POINT DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-5740
Mailing Address - Country:US
Mailing Address - Phone:803-562-2118
Mailing Address - Fax:803-419-3758
Practice Address - Street 1:4500 STUART ST
Practice Address - Street 2:
Practice Address - City:FORT JACKSON
Practice Address - State:SC
Practice Address - Zip Code:29207-5700
Practice Address - Country:US
Practice Address - Phone:803-562-2118
Practice Address - Fax:803-419-3758
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-05
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2994363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner