Healthcare Provider Details

I. General information

NPI: 1588869200
Provider Name (Legal Business Name): NANCY ANN OLSEN APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2007
Last Update Date: 05/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 W 95TH ST
EVERGREEN PARK IL
60805-2701
US

IV. Provider business mailing address

11413 FOXWOODS CT
OAK LAWN IL
60453-7115
US

V. Phone/Fax

Practice location:
  • Phone: 708-229-6067
  • Fax: 708-229-6065
Mailing address:
  • Phone: 708-229-6067
  • Fax: 708-229-6065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number209003255
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163WX1500X
TaxonomyOstomy Care Registered Nurse
License Number209003255
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number209003255
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: