Provider Demographics
NPI:1083766679
Name:OLIVE, DANA J (PHD, CRNP)
Entity type:Individual
Prefix:MRS
First Name:DANA
Middle Name:J
Last Name:OLIVE
Suffix:
Gender:F
Credentials:PHD, CRNP
Other - Prefix:MRS
Other - First Name:DANA
Other - Middle Name:J
Other - Last Name:HALLOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:1489 BALTIMORE PIKE STE 250
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:19064-3974
Mailing Address - Country:US
Mailing Address - Phone:610-544-2110
Mailing Address - Fax:
Practice Address - Street 1:1489 BALTIMORE PIKE STE 250
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:PA
Practice Address - Zip Code:19064-3974
Practice Address - Country:US
Practice Address - Phone:610-544-2110
Practice Address - Fax:610-327-3926
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAUP006574L163W00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
HA044986Medicare ID - Type Unspecified
P23254Medicare UPIN