Healthcare Provider Details

I. General information

NPI: 1629404546
Provider Name (Legal Business Name): MRS. MARY P. OLIVER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARY E. POLLY

II. Dates (important events)

Enumeration Date: 09/24/2013
Last Update Date: 09/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 DEADFALL RD W
GREENWOOD SC
29649-9546
US

IV. Provider business mailing address

431 DEADFALL ROAD WEST
GREENWOOD SC
29646
US

V. Phone/Fax

Practice location:
  • Phone: 864-941-3429
  • Fax: 864-388-2418
Mailing address:
  • Phone: 864-941-3429
  • Fax: 864-388-2418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number208182
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: