Healthcare Provider Details

I. General information

NPI: 1770491755
Provider Name (Legal Business Name): OLIVIA PAIGE TUCKER-WIGHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

847 JAMES ST # 110
SYRACUSE NY
13203-2504
US

IV. Provider business mailing address

3 BEACH RD
CLEVELAND NY
13042-3172
US

V. Phone/Fax

Practice location:
  • Phone: 315-492-1184
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number338255
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: