Healthcare Provider Details

I. General information

NPI: 1295604684
Provider Name (Legal Business Name): LD OLIVER III RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2025
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12605 E 16TH AVE
AURORA CO
80045-2545
US

IV. Provider business mailing address

1140 BANNOCK ST UNIT 1542
DENVER CO
80204-3833
US

V. Phone/Fax

Practice location:
  • Phone: 720-553-7846
  • Fax:
Mailing address:
  • Phone: 985-258-9396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN.1687763
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: