Provider Demographics
NPI:1528953957
Name:OLIVO, INGRID TILIANA (REGISTER NURSE)
Entity type:Individual
Prefix:
First Name:INGRID
Middle Name:TILIANA
Last Name:OLIVO
Suffix:
Gender:F
Credentials:REGISTER NURSE
Other - Prefix:
Other - First Name:INGRID
Other - Middle Name:TILIANA
Other - Last Name:MONTALVOHOMAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2501 W 22ND ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-1305
Mailing Address - Country:US
Mailing Address - Phone:605-336-3230
Mailing Address - Fax:612-725-1287
Practice Address - Street 1:2501 W 22ND ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1305
Practice Address - Country:US
Practice Address - Phone:605-336-3230
Practice Address - Fax:612-725-1287
Is Sole Proprietor?:No
Enumeration Date:2025-06-09
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR059637163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care