Healthcare Provider Details

I. General information

NPI: 1124389804
Provider Name (Legal Business Name): MICHELLE AVIVA OLIVER RN APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2012
Last Update Date: 05/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

261 JAMES ST SUITE 2G
MORRISTOWN NJ
07960-6392
US

IV. Provider business mailing address

261 JAMES ST SUITE 2G
MORRISTOWN NJ
07960-6392
US

V. Phone/Fax

Practice location:
  • Phone: 973-267-6400
  • Fax: 973-267-7295
Mailing address:
  • Phone: 973-267-6400
  • Fax: 973-267-7295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NJ00380000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: