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General NPI Number Information
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NPI Number | 1043903750
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Entity Type | Individual
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Provider Name | REBBECCA OLIVER AGACNP
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Gender | Female
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Dates
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Enumeration Date | 05/30/2023
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Last Update Date | 01/11/2024
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Provider Practice Location Address
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Address Line | 1900 N WASHINGTON AVE
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City | LIVINGSTON
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State | TX
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Zip | 77351-2105
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Country | US
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Telephone | 936-327-1015
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Fax | 888-815-1346
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Provider Business Mailing Address
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Address Line | 445 CAROLCREST LN APT 221
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City | LIVINGSTON
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State | TX
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Zip | 77351-7805
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Country | US
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Telephone | 936-215-3392
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 1123734
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License Number State | TX
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