Healthcare Provider Details

I. General information

NPI: 1053070128
Provider Name (Legal Business Name): JULIE MACKENZIE OLIVER NNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2021
Last Update Date: 04/15/2022
Certification Date: 04/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2131 S 17TH ST
WILMINGTON NC
28401-7407
US

IV. Provider business mailing address

5438 MARINA CLUB DR
WILMINGTON NC
28409-4104
US

V. Phone/Fax

Practice location:
  • Phone: 240-447-0364
  • Fax:
Mailing address:
  • Phone: 240-447-0364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number5001807
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: