Healthcare Provider Details

I. General information

NPI: 1871354696
Provider Name (Legal Business Name): ABAGAIL OLAVESON APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ABAGAIL ERICKSON

II. Dates (important events)

Enumeration Date: 01/18/2024
Last Update Date: 01/16/2025
Certification Date: 01/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 S RISING SUN DR STE 120
NAMPA ID
83686-6000
US

IV. Provider business mailing address

920 S RISING SUN DR STE 120
NAMPA ID
83686-6000
US

V. Phone/Fax

Practice location:
  • Phone: 208-515-2273
  • Fax: 208-515-2274
Mailing address:
  • Phone: 208-515-2273
  • Fax: 208-515-2274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number9961773
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number55750
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: