Healthcare Provider Details

I. General information

NPI: 1023459005
Provider Name (Legal Business Name): KATHLEEN OLSEN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2013
Last Update Date: 06/13/2023
Certification Date: 06/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8420 W BRYN MAWR AVE STE 300
CHICAGO IL
60631-3436
US

IV. Provider business mailing address

PO BOX 443
BEDFORD PARK IL
60499-0443
US

V. Phone/Fax

Practice location:
  • Phone: 773-756-5780
  • Fax: 773-714-1353
Mailing address:
  • Phone: 773-756-5780
  • Fax: 773-714-1353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209012168
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: