Individual
MS. DONNA OLIVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
400 W 16TH ST, PUEBLO, CO 81003-2745
(719) 584-4306
Mailing address
400 W 16TH ST, PUEBLO, CO 81003-2745
(719) 584-4306
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA.0000674
CO
363AM0700X
Medical Physician Assistant
674
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
72509325
—
CO
Enumeration date
08/05/2006
Last updated
01/28/2015
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