Healthcare Provider Details

I. General information

NPI: 1316961212
Provider Name (Legal Business Name): EVELYN PATRICIA OLIVER CRT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14416 TIMBER RIDGE DR
MOSS POINT MS
39562-8790
US

IV. Provider business mailing address

14416 TIMBER RIDGE DR
MOSS POINT MS
39562-8790
US

V. Phone/Fax

Practice location:
  • Phone: 228-474-6065
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2278C0205X
TaxonomyCritical Care Certified Respiratory Therapist
License Number1426
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: