Healthcare Provider Details

I. General information

NPI: 1104807619
Provider Name (Legal Business Name): JANICE L OLSON NP FAMILY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 05/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6973 LINDA VISTA RD
SAN DIEGO CA
92111-6339
US

IV. Provider business mailing address

1025 STRATTON DR
VISTA CA
92083-4778
US

V. Phone/Fax

Practice location:
  • Phone: 858-279-9676
  • Fax: 858-279-0377
Mailing address:
  • Phone: 760-221-4823
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberFNP7509
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN306836
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberFNP7509
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: