Healthcare Provider Details

I. General information

NPI: 1881472058
Provider Name (Legal Business Name): OLIVIA G GOLD APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: OLIVIA G HOLLEY APRN

II. Dates (important events)

Enumeration Date: 09/19/2023
Last Update Date: 09/19/2024
Certification Date: 09/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7100 W CENTER RD
OMAHA NE
68106-2714
US

IV. Provider business mailing address

7100 W CENTER RD
OMAHA NE
68106-2714
US

V. Phone/Fax

Practice location:
  • Phone: 402-506-9000
  • Fax: 402-506-9093
Mailing address:
  • Phone: 402-506-9000
  • Fax: 402-506-9093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number114993
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: