MEDICARE: DEVAN NICOLE OLAH

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	247200000X	Other Technician

General Provider Information

NPI Number	:	1952750580
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEVAN NICOLE OLAH

Provider Business Mailing Address
First Line	:	688 W OXHILL DR
Second Line	:
City	:	WHITE LAKE
State	:	MI
Zip	:	48386-2352
Country	:	US
Telephone Number	:	248-821-2250
Fax Number	:

Provider Business Practice Location Address
First Line	:	688 W OXHILL DR
Second Line	:
City	:	WHITE LAKE
State	:	MI
Zip	:	48386-2352
Country	:	US
Telephone Number	:	248-821-2250
Fax Number	:

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

Provider Enumeration Date	:	06/04/2016
Last Update Date	:	06/04/2016

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