Provider Demographics
NPI:1063516466
Name:MEADOWS-OLIVER, MIKKI (APRN)
Entity type:Individual
Prefix:
First Name:MIKKI
Middle Name:
Last Name:MEADOWS-OLIVER
Suffix:
Gender:F
Credentials:APRN
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Other - Credentials:
Mailing Address - Street 1:PO BOX 18263
Mailing Address - Street 2:SAINT RAPHAEL FACULTY PHYSICIANS
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06601-3263
Mailing Address - Country:US
Mailing Address - Phone:508-595-0531
Mailing Address - Fax:508-829-5367
Practice Address - Street 1:1450 CHAPEL ST.
Practice Address - Street 2:SAINT RAPHAEL FACULTY PHYSICIANS
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511
Practice Address - Country:US
Practice Address - Phone:203-789-4074
Practice Address - Fax:203-867-5534
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT001976363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
P78980Medicare UPIN