Healthcare Provider Details

I. General information

NPI: 1487089843
Provider Name (Legal Business Name): OLIVIA P WASHINGTON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2013
Last Update Date: 09/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 GOES IN LODGE ROAD
RIVERTON WY
82501
US

IV. Provider business mailing address

43 GOES IN LODGE ROAD
RIVERTON WY
82501-0000
US

V. Phone/Fax

Practice location:
  • Phone: 307-851-8351
  • Fax: 307-332-0131
Mailing address:
  • Phone: 307-851-8351
  • Fax: 307-332-0131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number32495
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: