Provider Demographics
NPI:1265708283
Name:JO ANNE NOWICK OLIVER, PA
Entity type:Organization
Organization Name:JO ANNE NOWICK OLIVER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:COLE
Authorized Official - Middle Name:
Authorized Official - Last Name:DALTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-891-4330
Mailing Address - Street 1:207 W HICKORY ST
Mailing Address - Street 2:SUITE 114
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-4156
Mailing Address - Country:US
Mailing Address - Phone:940-891-4330
Mailing Address - Fax:940-891-4330
Practice Address - Street 1:207 W HICKORY ST
Practice Address - Street 2:SUITE 114
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-4156
Practice Address - Country:US
Practice Address - Phone:940-891-4330
Practice Address - Fax:940-891-4330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-23
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX00865261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health