=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598001596
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BERNADETTE OLIVIER ENTERPRISES, INCORPORATED
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/19/2012
-----------------------------------------------------
Last Update Date | 08/29/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2552 BROADWAY ST SUITE 102
-----------------------------------------------------
City | PEARLAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77581-4904
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-485-2886
-----------------------------------------------------
Fax | 281-485-6964
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2552 BROADWAY ST SUITE 102
-----------------------------------------------------
City | PEARLAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77581-4904
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-485-2886
-----------------------------------------------------
Fax | 281-485-6964
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PROVIDER
-----------------------------------------------------
Name | MR. BERNADETTE NICOLE OLIVIER
-----------------------------------------------------
Credential | RNC, CNM, MSN
-----------------------------------------------------
Telephone | 281-485-2886
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QB0400X
-----------------------------------------------------
Taxonomy Name | Birthing Clinic/Center
-----------------------------------------------------
License Number | 008365
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------