Healthcare Provider Details

I. General information

NPI: 1861948952
Provider Name (Legal Business Name): SAMANTHA A OLESEN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SAMANTHA A GOVE FNP-C

II. Dates (important events)

Enumeration Date: 08/29/2016
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3980 DOUGLAS BLVD STE 110
ROSEVILLE CA
95661-4263
US

IV. Provider business mailing address

3400 DATA DR
RANCHO CORDOVA CA
95670-7956
US

V. Phone/Fax

Practice location:
  • Phone: 916-293-4400
  • Fax: 916-293-4401
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95004789
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: