MEDICARE: JENNA OLIVER FNP-BC

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	363LF0000X	Family Nurse Practitioner	4704375786	MI

General Provider Information

NPI Number	:	1871300590
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNA OLIVER FNP-BC

Provider Business Mailing Address
First Line	:	232 W LAFAYETTE ST
Second Line	:
City	:	ROMEO
State	:	MI
Zip	:	48065-5182
Country	:	US
Telephone Number	:	248-736-7331
Fax Number	:

Provider Business Practice Location Address
First Line	:	2252 PARIS DR
Second Line	:
City	:	TROY
State	:	MI
Zip	:	48083-2320
Country	:	US
Telephone Number	:	248-736-7331
Fax Number	:

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

Provider Enumeration Date	:	12/16/2024
Last Update Date	:	02/03/2026

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