Individual
KIMBERLY OLIVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7910 W JEFFERSON BLVD STE 102, FORT WAYNE, IN 46804-4159
(260) 436-2424
Mailing address
7910 W JEFFERSON BLVD STE 102, FORT WAYNE, IN 46804-4159
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71005030A
IN
Other
Enumeration date
08/19/2014
Last updated
08/19/2014
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