Healthcare Provider Details

I. General information

NPI: 1083766679
Provider Name (Legal Business Name): DANA J OLIVE PHD, CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DANA J HALLOCK CRNP

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 01/30/2023
Certification Date: 01/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1489 BALTIMORE PIKE STE 250
SPRINGFIELD PA
19064-3974
US

IV. Provider business mailing address

1489 BALTIMORE PIKE STE 250
SPRINGFIELD PA
19064-3974
US

V. Phone/Fax

Practice location:
  • Phone: 610-544-2110
  • Fax: 610-327-3926
Mailing address:
  • Phone: 610-544-2110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberUP006574L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberUP006574L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: