Healthcare Provider Details

I. General information

NPI: 1780672782
Provider Name (Legal Business Name): PATRICIA VIOLA OLSON MS RNC WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8645 CONNECTICUT ST
MERRILLVILLE IN
46410-6222
US

IV. Provider business mailing address

415 SWAN DR
DYER IN
46311-1072
US

V. Phone/Fax

Practice location:
  • Phone: 219-769-3500
  • Fax: 319-791-0538
Mailing address:
  • Phone: 219-865-0340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number71001058A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: