MEDICARE: ANGELA OLSEN FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	29961	SC

General Provider Information

NPI Number	:	1255146841
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA OLSEN FNP

Provider Business Mailing Address
First Line	:	168 GIVHANS LOOP
Second Line	:
City	:	HARDEEVILLE
State	:	SC
Zip	:	29927-2444
Country	:	US
Telephone Number	:	843-806-8388
Fax Number	:

Provider Business Practice Location Address
First Line	:	122 OKATIE CENTER BLVD N STE 100
Second Line	:
City	:	OKATIE
State	:	SC
Zip	:	29909-3782
Country	:	US
Telephone Number	:	843-806-8388
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/11/2025
Last Update Date	:	02/11/2025

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