Healthcare Provider Details

I. General information

NPI: 1235642661
Provider Name (Legal Business Name): CHRISTOPHER OLSEN ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2017
Last Update Date: 05/13/2022
Certification Date: 05/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 MAPLE ST
ATLANTIC IA
50022-1554
US

IV. Provider business mailing address

611 MAPLE ST
ATLANTIC IA
50022-1554
US

V. Phone/Fax

Practice location:
  • Phone: 402-917-5065
  • Fax:
Mailing address:
  • Phone: 402-917-5065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number112566
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberH157790
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: