Healthcare Provider Details

I. General information

NPI: 1336066422
Provider Name (Legal Business Name): OLIVIA DEANE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: OLIVIA WISNIEWSKI RN

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 N MCQUEEN RD UNIT 1076
CHANDLER AZ
85225-3952
US

IV. Provider business mailing address

4240 S ARIZONA AVE # 1011
CHANDLER AZ
85248-4593
US

V. Phone/Fax

Practice location:
  • Phone: 480-678-5392
  • Fax:
Mailing address:
  • Phone: 480-678-5392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number240373
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: