Healthcare Provider Details

I. General information

NPI: 1447699129
Provider Name (Legal Business Name): CHRISTINA J OLIVE FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2013
Last Update Date: 11/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 E MAIN ST
AMANDA OH
43102-1111
US

IV. Provider business mailing address

1153 E MAIN ST PO BOX 2563
LANCASTER OH
43130-4056
US

V. Phone/Fax

Practice location:
  • Phone: 740-969-4828
  • Fax: 740-969-4818
Mailing address:
  • Phone: 740-687-8990
  • Fax: 740-687-8230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA.14524-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: