Healthcare Provider Details

I. General information

NPI: 1023130622
Provider Name (Legal Business Name): LAUREL JEAN OLSLUND N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 11/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 ASHBY AVE
BERKELEY CA
94705-2067
US

IV. Provider business mailing address

411 30TH ST STE 314
OAKLAND CA
94609-3312
US

V. Phone/Fax

Practice location:
  • Phone: 510-204-3991
  • Fax: 510-841-0435
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number729
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number7944
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: