Provider Demographics
NPI:1699479220
Name:OLIVER, BENITA
Entity type:Individual
Prefix:
First Name:BENITA
Middle Name:
Last Name:OLIVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BENITA
Other - Middle Name:NICOLE-HAZEL
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9645 BRAMELL
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48239-1369
Mailing Address - Country:US
Mailing Address - Phone:313-303-3807
Mailing Address - Fax:
Practice Address - Street 1:9645 BRAMELL
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48239-1369
Practice Address - Country:US
Practice Address - Phone:313-303-3807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-28
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No251E00000XAgenciesHome Health
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle
No347E00000XTransportation ServicesTransportation Broker
No372500000XNursing Service Related ProvidersChore Provider