Provider Demographics
NPI:1386173052
Name:OLIVER, JILLIAN RENEE (MS)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:RENEE
Last Name:OLIVER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 98TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-7605
Mailing Address - Country:US
Mailing Address - Phone:516-807-7014
Mailing Address - Fax:
Practice Address - Street 1:7616 13TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-2412
Practice Address - Country:US
Practice Address - Phone:718-630-5100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-07
Last Update Date:2017-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program