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General NPI Number Information
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NPI Number | 1215663406
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Entity Type | Individual
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Provider Name | ALEXANDRIA DANIELLE OLIVER AT
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Gender | Female
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Dates
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Enumeration Date | 07/28/2022
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Last Update Date | 07/28/2022
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Provider Practice Location Address
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Address Line | 1 UNIVERSITY RD
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City | PEMBROKE
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State | NC
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Zip | 28372-8699
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Country | US
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Telephone | 910-775-4106
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Fax |
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Provider Business Mailing Address
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Address Line | 101 ASHLEY RD
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City | CLEMSON
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State | SC
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Zip | 29631-1770
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Country | US
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Telephone |
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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