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General NPI Number Information
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NPI Number | 1295604684
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Entity Type | Individual
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Provider Name | LD OLIVER III RN
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Gender | Male
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Dates
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Enumeration Date | 11/03/2025
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Last Update Date | 11/03/2025
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Provider Practice Location Address
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Address Line | 12605 E 16TH AVE
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City | AURORA
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State | CO
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Zip | 80045-2545
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Country | US
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Telephone | 720-553-7846
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Fax |
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Provider Business Mailing Address
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Address Line | 1140 BANNOCK ST UNIT 1542
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City | DENVER
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State | CO
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Zip | 80204-3833
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Country | US
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Telephone | 985-258-9396
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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 | 163WE0003X
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Taxonomy Name | Emergency Registered Nurse
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License Number | RN.1687763
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License Number State | CO
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