Healthcare Provider Details

I. General information

NPI: 1245001510
Provider Name (Legal Business Name): OLIVIA VUE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2024
Last Update Date: 01/15/2024
Certification Date: 01/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

731 BIELENBERG DR
WOODBURY MN
55125-1700
US

IV. Provider business mailing address

10760 MAPLE BLVD
WOODBURY MN
55129-8320
US

V. Phone/Fax

Practice location:
  • Phone: 612-445-8326
  • Fax:
Mailing address:
  • Phone: 612-964-1579
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: