Healthcare Provider Details

I. General information

NPI: 1396675468
Provider Name (Legal Business Name): WESLEY OLIVER
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 W ST NW
WASHINGTON DC
20059-1021
US

IV. Provider business mailing address

520 W ST NW
WASHINGTON DC
20059-1021
US

V. Phone/Fax

Practice location:
  • Phone: 205-367-7571
  • Fax: 205-367-7571
Mailing address:
  • Phone: 205-367-7571
  • Fax: 205-367-7571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: