Provider Demographics
NPI:1215252929
Name:OLIVER, CAMERON R (RN, CRNA)
Entity type:Individual
Prefix:
First Name:CAMERON
Middle Name:R
Last Name:OLIVER
Suffix:
Gender:
Credentials:RN, CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8808 LOST RIVER RD
Mailing Address - Street 2:
Mailing Address - City:HORACE
Mailing Address - State:ND
Mailing Address - Zip Code:58047-9742
Mailing Address - Country:US
Mailing Address - Phone:507-226-1087
Mailing Address - Fax:
Practice Address - Street 1:2101 ELM STREET FARGO
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102
Practice Address - Country:US
Practice Address - Phone:701-232-3241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-06
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH15699-NA367500000X
WI5721-33367500000X
IAD125794367500000X
COAPN0991084CRNA367500000X
FLARNP9289597367500000X
NY683051367500000X
PARN656096367500000X
TXAP125440367500000X
MNR1815566367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNENROLLEDMedicaid
MN430007053Medicare PIN