Individual
MRS. OLIVIA MACKENZIE KING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
4322 LAFAYETTE BLVD., SOUTH BEND, IN 46614
(574) 391-1111
(574) 859-5040
Mailing address
4322 LAFAYETTE BLVD., SOUTH BEND, IN 46614
(574) 391-1111
(574) 859-5040
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
08/26/2024
Last updated
08/26/2024
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