Healthcare Provider Details

I. General information

NPI: 1093297822
Provider Name (Legal Business Name): SHARON DARLENE OLIVER RN, WOCRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2018
Last Update Date: 08/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 N 2ND ST
LOGAN NM
88426-9835
US

IV. Provider business mailing address

301 N 2ND ST
LOGAN NM
88426-9835
US

V. Phone/Fax

Practice location:
  • Phone: 575-487-2252
  • Fax:
Mailing address:
  • Phone: 575-487-2252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberR38361
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: