Healthcare Provider Details

I. General information

NPI: 1629304639
Provider Name (Legal Business Name): JANET KAY OLSON APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2009
Last Update Date: 05/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11022 S 51ST ST STE 101
PHOENIX AZ
85044
US

IV. Provider business mailing address

11022 S 51ST ST STE 101
PHOENIX AZ
85044-1789
US

V. Phone/Fax

Practice location:
  • Phone: 708-308-0852
  • Fax: 480-383-6371
Mailing address:
  • Phone: 708-308-0852
  • Fax: 480-383-6371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number209007853
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number209007853
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP7656
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: