Healthcare Provider Details

I. General information

NPI: 1861130320
Provider Name (Legal Business Name): ELIZABETH A OLMSTEAD RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2022
Last Update Date: 01/03/2024
Certification Date: 01/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 FOX RIDGE RD
WARSAW NC
28398-9588
US

IV. Provider business mailing address

308 FOX RIDGE RD
WARSAW NC
28398-9588
US

V. Phone/Fax

Practice location:
  • Phone: 309-678-3470
  • Fax:
Mailing address:
  • Phone: 309-678-3470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704363047
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number323012
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number041376043
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number323012
License Number StateNC
# 5
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: