Healthcare Provider Details

I. General information

NPI: 1538816632
Provider Name (Legal Business Name): OLIVIA DOWNS LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2022
Last Update Date: 03/08/2022
Certification Date: 02/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1404 E CHURCH
WARREN AR
71671
US

IV. Provider business mailing address

1404 E CHURCH
WARREN AR
71671
US

V. Phone/Fax

Practice location:
  • Phone: 870-367-2461
  • Fax:
Mailing address:
  • Phone: 870-367-2461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number20182373
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: