Healthcare Provider Details

I. General information

NPI: 1013805134
Provider Name (Legal Business Name): OLIVIA TAYLOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2025
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 S COUNTRY CLUB DR STE 3
MESA AZ
85210-5162
US

IV. Provider business mailing address

17617 WOOLWORTH AVE
OMAHA NE
68130-4617
US

V. Phone/Fax

Practice location:
  • Phone: 480-827-5500
  • Fax:
Mailing address:
  • Phone: 402-677-8149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberR82407
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: