MEDICARE: SUZANNE OLIVER LPN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	26892	NE

General Provider Information

NPI Number	:	1679373088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUZANNE OLIVER LPN

Provider Business Mailing Address
First Line	:	1400 S E ST
Second Line	:
City	:	BROKEN BOW
State	:	NE
Zip	:	68822-2320
Country	:	US
Telephone Number	:	308-870-4221
Fax Number	:

Provider Business Practice Location Address
First Line	:	1811 W 2ND ST STE LL200
Second Line	:
City	:	GRAND ISLAND
State	:	NE
Zip	:	68803-5420
Country	:	US
Telephone Number	:	308-833-3981
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/14/2025
Last Update Date	:	03/14/2025

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Directions to “ SUZANNE OLIVER LPN” Practice Location

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