Healthcare Provider Details

I. General information

NPI: 1487141057
Provider Name (Legal Business Name): ERICKA NATASHA OLIVER-LINEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ERICKA NATASHA OLIVER MD

II. Dates (important events)

Enumeration Date: 04/18/2018
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22201 MOROSS RD STE 222
DETROIT MI
48236-2169
US

IV. Provider business mailing address

1 CHILDRENS PL CB 8116
ST. LOUIS MO
63110
US

V. Phone/Fax

Practice location:
  • Phone: 313-343-3964
  • Fax:
Mailing address:
  • Phone: 314-454-2527
  • Fax: 314-747-8880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2021025587
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301502421
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2021013996
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number4301502421
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: