MEDICARE: JOHN OLIVER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator		AK

General Provider Information

NPI Number	:	1659204212
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN OLIVER

Provider Business Mailing Address
First Line	:	8611 UPPER DE ARMOUN RD
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99516-3366
Country	:	US
Telephone Number	:	907-830-7314
Fax Number	:

Provider Business Practice Location Address
First Line	:	8611 UPPER DE ARMOUN RD
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99516-3366
Country	:	US
Telephone Number	:	907-830-7314
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2026
Last Update Date	:	06/04/2026

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