Provider Demographics
NPI:1528132602
Name:OLIVER, STEVEN WAYNE
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:WAYNE
Last Name:OLIVER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:STEVE
Other - Middle Name:WAYNE
Other - Last Name:OLIVER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:HWY 173 #826
Mailing Address - Street 2:
Mailing Address - City:BREWSTER
Mailing Address - State:WA
Mailing Address - Zip Code:98812
Mailing Address - Country:US
Mailing Address - Phone:509-689-0991
Mailing Address - Fax:509-689-0819
Practice Address - Street 1:427 HWY 20 EAST
Practice Address - Street 2:SUITE #A
Practice Address - City:TWISP
Practice Address - State:WA
Practice Address - Zip Code:98856
Practice Address - Country:US
Practice Address - Phone:509-689-0991
Practice Address - Fax:509-689-0819
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA9055070332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9055070Medicaid
WA9058181Medicaid
WA9058181Medicaid