MEDICARE: JENNIFER ROSE OLIVER

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	363LF0000X	Family Nurse Practitioner	APRN.CNP.0028477	OH
2	363L00000X	Nurse Practitioner	APRN.CNP.0028477	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1344572-0001	OTHER	OH	BWC

General Provider Information

NPI Number	:	1952074155
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER ROSE OLIVER

Provider Business Mailing Address
First Line	:	1140 S KNOXVILLE AVE STE D
Second Line	:
City	:	SAINT MARYS
State	:	OH
Zip	:	45885-2609
Country	:	US
Telephone Number	:	193-001-1294
Fax Number	:	419-394-9575

Provider Business Practice Location Address
First Line	:	1013 E SPRING ST
Second Line	:
City	:	SAINT MARYS
State	:	OH
Zip	:	45885-2447
Country	:	US
Telephone Number	:	419-394-8664
Fax Number	:	419-394-1148

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

Provider Enumeration Date	:	07/26/2021
Last Update Date	:	08/28/2023

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Directions to “ JENNIFER ROSE OLIVER ” Practice Location

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