Healthcare Provider Details

I. General information

NPI: 1700296498
Provider Name (Legal Business Name): EMILY OLIVER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2014
Last Update Date: 05/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 COURAGE DR
FAIRFIELD CA
94533-6717
US

IV. Provider business mailing address

2101 COURAGE DR
FAIRFIELD CA
94533-6717
US

V. Phone/Fax

Practice location:
  • Phone: 916-803-1264
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number852143
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: