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General NPI Number Information
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NPI Number | 1932913712
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Entity Type | Individual
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Provider Name | KISHA P OLIVER MEDICAL PEDICURIST
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Gender | Female
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Dates
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Enumeration Date | 02/03/2025
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Last Update Date | 02/03/2025
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Provider Practice Location Address
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Address Line | 14917 AMBAUM BLVD SW
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City | BURIEN
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State | WA
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Zip | 98166-1847
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Country | US
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Telephone | 206-501-1264
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Fax |
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Provider Business Mailing Address
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Address Line | 12520 ROOSEVELT WAY NE APT 303
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City | SEATTLE
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State | WA
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Zip | 98125-3948
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Country | US
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Telephone | 206-501-1264
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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 | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | E2100-100167
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License Number State | WA
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