Healthcare Provider Details

I. General information

NPI: 1104348317
Provider Name (Legal Business Name): AMANDABRETT OLIVER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MANDY OLIVER

II. Dates (important events)

Enumeration Date: 07/10/2017
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14137 LAKERIDGE CIR
MAGALIA CA
95954-9470
US

IV. Provider business mailing address

14137 LAKERIDGE CIR
MAGALIA CA
95954-9470
US

V. Phone/Fax

Practice location:
  • Phone: 530-873-5030
  • Fax:
Mailing address:
  • Phone: 530-873-5030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95037849
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN682543
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: