Healthcare Provider Details

I. General information

NPI: 1427634468
Provider Name (Legal Business Name): AMANDA SHERMAINE OLIVER DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2021
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 MISSILE AVE
MINOT AFB ND
58705-5003
US

IV. Provider business mailing address

10 MISSILE AVE
MINOT AFB ND
58705-5003
US

V. Phone/Fax

Practice location:
  • Phone: 701-723-5221
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0102207543
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: