Provider Demographics
NPI:1861182966
Name:OLIVER, JENNIFER (CPT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:OLIVER
Suffix:
Gender:F
Credentials:CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5444 DIAMOND ST
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19131-3111
Mailing Address - Country:US
Mailing Address - Phone:267-545-8573
Mailing Address - Fax:
Practice Address - Street 1:5444 DIAMOND ST
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19131-3111
Practice Address - Country:US
Practice Address - Phone:267-545-8573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-11
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAA3L5H7M8246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy