=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952546954
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARY ANNE OLIVER APRN-BC, FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/05/2008
-----------------------------------------------------
Last Update Date | 06/06/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4500 STUART ST
-----------------------------------------------------
City | FORT JACKSON
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29207-5700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-562-2118
-----------------------------------------------------
Fax | 803-419-3758
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1021 PINNACLE POINT DR SUITE 200
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29223-5740
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-562-2118
-----------------------------------------------------
Fax | 803-419-3758
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 2994
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------