Healthcare Provider Details

I. General information

NPI: 1295383305
Provider Name (Legal Business Name): ERIC-PAUL ERNEST OLSSON CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2019
Last Update Date: 02/17/2026
Certification Date: 02/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

154 WELLS AVE STE 1A
NEWTON MA
02459-3347
US

IV. Provider business mailing address

154 WELLS AVE STE 1A
NEWTON MA
02459-3347
US

V. Phone/Fax

Practice location:
  • Phone: 774-290-4175
  • Fax: 617-329-7799
Mailing address:
  • Phone: 774-290-4175
  • Fax: 617-329-7799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN2278858
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN2278858
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: