Provider Demographics
NPI:1871113456
Name:OLIVER, LYDIA
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:
Last Name:OLIVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-1163
Mailing Address - Country:US
Mailing Address - Phone:605-391-1466
Mailing Address - Fax:605-342-3692
Practice Address - Street 1:111 NORTH ST
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-1163
Practice Address - Country:US
Practice Address - Phone:605-391-1466
Practice Address - Fax:605-342-3692
Is Sole Proprietor?:No
Enumeration Date:2020-04-23
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator