Provider Demographics
NPI:1407604036
Name:TATOM, OLIVER (RN)
Entity type:Individual
Prefix:
First Name:OLIVER
Middle Name:
Last Name:TATOM
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 NW WALL ST
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-2608
Mailing Address - Country:US
Mailing Address - Phone:541-355-1000
Mailing Address - Fax:
Practice Address - Street 1:3030 NW ELWOOD LN
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-7200
Practice Address - Country:US
Practice Address - Phone:541-355-6922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-08
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201904947RN163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool