Healthcare Provider Details

I. General information

NPI: 1225482250
Provider Name (Legal Business Name): OLIVIA HAWLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2016
Last Update Date: 04/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 MAPLE DR
POCA WV
25159-7546
US

IV. Provider business mailing address

34 MAPLE DR
POCA WV
25159-7546
US

V. Phone/Fax

Practice location:
  • Phone: 304-380-4830
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number028695
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: