Individual
ANDREA ALEXIS OLIPHANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATP
Contact information
Practice address
2601 W MOCKINGBIRD LN STE 101, DALLAS, TX 75235-5630
(214) 951-9710
(214) 951-9720
Mailing address
2601 W MOCKINGBIRD LN STE 101, DALLAS, TX 75235-5630
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
ATP89315
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
89315
RESNA
TX
Enumeration date
02/18/2019
Last updated
02/18/2019
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