Healthcare Provider Details

I. General information

NPI: 1912419383
Provider Name (Legal Business Name): ELIZABETH LYNN OLIVER FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2017
Last Update Date: 09/12/2025
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

243 THREE SPRINGS DR STE 5A
WEIRTON WV
26062-3839
US

IV. Provider business mailing address

PO BOX 645532
PITTSBURGH PA
15264-5253
US

V. Phone/Fax

Practice location:
  • Phone: 740-792-4220
  • Fax: 740-275-4472
Mailing address:
  • Phone: 740-792-4220
  • Fax: 740-275-4472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number349075
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP022061
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN90483
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: