Provider Demographics
NPI:1104533348
Name:PITTMAN, OLEAN DENISE
Entity type:Individual
Prefix:
First Name:OLEAN
Middle Name:DENISE
Last Name:PITTMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24224 MS HIGHWAY 15
Mailing Address - Street 2:
Mailing Address - City:MATHISTON
Mailing Address - State:MS
Mailing Address - Zip Code:39752-6876
Mailing Address - Country:US
Mailing Address - Phone:662-263-3194
Mailing Address - Fax:
Practice Address - Street 1:24224 MS HIGHWAY 15
Practice Address - Street 2:
Practice Address - City:MATHISTON
Practice Address - State:MS
Practice Address - Zip Code:39752-6876
Practice Address - Country:US
Practice Address - Phone:662-263-3194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-27
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS002482251E00000X, 376J00000X
MS3996376J00000X, 376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No251E00000XAgenciesHome Health