Provider Demographics
NPI:1306173703
Name:OLIVER, DAGNY M (CNM)
Entity type:Individual
Prefix:
First Name:DAGNY
Middle Name:M
Last Name:OLIVER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 CENTRACARE CIRCLE #2300
Mailing Address - Street 2:CENTRACARE CLINIC-WOMEN'S & CHILDRENS
Mailing Address - City:ST CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-5000
Mailing Address - Country:US
Mailing Address - Phone:320-654-3660
Mailing Address - Fax:
Practice Address - Street 1:1900 CENTRACARE CIRCLE #2300
Practice Address - Street 2:CENTRACARE CLINIC-WOMEN'S & CHILDRENS
Practice Address - City:ST CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-5000
Practice Address - Country:US
Practice Address - Phone:320-654-3660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-06
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR-144852-2367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife