Provider Demographics
NPI:1306099973
Name:OLIAI, JACQUELYN MAY (NP)
Entity type:Individual
Prefix:MRS
First Name:JACQUELYN
Middle Name:MAY
Last Name:OLIAI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JACQUELYN
Other - Middle Name:MAY
Other - Last Name:ORCHARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:100 MICHIGAN ST NE
Mailing Address - Street 2:MC 845
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:275 MICHIGAN ST NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-2531
Practice Address - Country:US
Practice Address - Phone:616-391-2802
Practice Address - Fax:616-391-2840
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704145586363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner