Healthcare Provider Details

I. General information

NPI: 1154177269
Provider Name (Legal Business Name): EMILY JOY OLSON MSN, AGPCNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2024
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6268 N TRAILWOODS DR
ANN ARBOR MI
48103-2292
US

IV. Provider business mailing address

6268 N TRAILWOODS DR
ANN ARBOR MI
48103-2292
US

V. Phone/Fax

Practice location:
  • Phone: 616-481-7025
  • Fax:
Mailing address:
  • Phone: 616-481-7025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number4704310806
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704310806
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPRN.CNP.0037431
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: