Healthcare Provider Details

I. General information

NPI: 1467382580
Provider Name (Legal Business Name): NANGE OLIVACCE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2404 N STOCKTON HILL RD STE A
KINGMAN AZ
86401-4184
US

IV. Provider business mailing address

1270 SPRING ST NW UNIT 209
ATLANTA GA
30309-2895
US

V. Phone/Fax

Practice location:
  • Phone: 800-662-4357
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number339500
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: