Healthcare Provider Details

I. General information

NPI: 1750324216
Provider Name (Legal Business Name): JEANINNE OLIVER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 07/21/2022
Certification Date: 06/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1993 ERRECART BLVD
ELKO NV
89801-8334
US

IV. Provider business mailing address

1993 ERRECART BLVD
ELKO NV
89801-8334
US

V. Phone/Fax

Practice location:
  • Phone: 775-753-1049
  • Fax: 775-777-8494
Mailing address:
  • Phone: 775-753-1049
  • Fax: 775-777-8494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9109398
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: