Provider Demographics
NPI:1114350170
Name:OLIVER, DAMON MBOYA JR (STNA)
Entity type:Individual
Prefix:MR
First Name:DAMON
Middle Name:MBOYA
Last Name:OLIVER
Suffix:JR
Gender:M
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6065 STOVER AVE
Mailing Address - Street 2:APT2
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45237-4750
Mailing Address - Country:US
Mailing Address - Phone:513-432-8080
Mailing Address - Fax:
Practice Address - Street 1:6065 STOVER AVEUE
Practice Address - Street 2:APT2
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45237
Practice Address - Country:US
Practice Address - Phone:513-432-8080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-14
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH321727281212376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide