Provider Demographics
NPI:1962209478
Name:OLIVER, NICOLE DANIELLE
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:DANIELLE
Last Name:OLIVER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 MINISINK TRL
Mailing Address - Street 2:
Mailing Address - City:GLEN SPEY
Mailing Address - State:NY
Mailing Address - Zip Code:12737-8003
Mailing Address - Country:US
Mailing Address - Phone:518-596-3686
Mailing Address - Fax:
Practice Address - Street 1:107 MINISINK TRL
Practice Address - Street 2:
Practice Address - City:GLEN SPEY
Practice Address - State:NY
Practice Address - Zip Code:12737-8003
Practice Address - Country:US
Practice Address - Phone:518-596-3686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY518015163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse