Healthcare Provider Details

I. General information

NPI: 1720617228
Provider Name (Legal Business Name): KIERSTEN E. OLSEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2020
Last Update Date: 07/11/2024
Certification Date: 07/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 S LEBANON ST
LEBANON IN
46052-3076
US

IV. Provider business mailing address

2605 N LEBANON ST
LEBANON IN
46052-1476
US

V. Phone/Fax

Practice location:
  • Phone: 765-680-0071
  • Fax: 765-436-0455
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number01089961A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: