Healthcare Provider Details

I. General information

NPI: 1114857745
Provider Name (Legal Business Name): SANDRA OLIVER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2026
Last Update Date: 05/25/2026
Certification Date: 05/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1819 WOOD ST
WHEELING WV
26003-3607
US

IV. Provider business mailing address

73 SANDY DR
BENWOOD WV
26031-1382
US

V. Phone/Fax

Practice location:
  • Phone: 304-281-2845
  • Fax:
Mailing address:
  • Phone: 304-281-2845
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number17601
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: