Provider Demographics
NPI:1679373088
Name:OLIVER, SUZANNE (LPN)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:OLIVER
Suffix:
Gender:
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 S E ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN BOW
Mailing Address - State:NE
Mailing Address - Zip Code:68822-2320
Mailing Address - Country:US
Mailing Address - Phone:308-870-4221
Mailing Address - Fax:
Practice Address - Street 1:1811 W 2ND ST STE LL200
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-5420
Practice Address - Country:US
Practice Address - Phone:308-833-3981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-14
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE26892164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse