Healthcare Provider Details

I. General information

NPI: 1588217129
Provider Name (Legal Business Name): TERRIA OLIVER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2019
Last Update Date: 07/12/2023
Certification Date: 07/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4465 S. BUFFALO DR. STE A-E
LAS VEAGS NV
89147-5006
US

IV. Provider business mailing address

4465 S BUFFALO DR STE A-E
LAS VEGAS NV
89147-5006
US

V. Phone/Fax

Practice location:
  • Phone: 702-665-4514
  • Fax:
Mailing address:
  • Phone: 702-665-4514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: