Healthcare Provider Details

I. General information

NPI: 1649984055
Provider Name (Legal Business Name): NICOLE OLSON RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2023
Last Update Date: 04/15/2024
Certification Date: 04/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8701 PACIFIC ST
OMAHA NE
68114-5298
US

IV. Provider business mailing address

8701 PACIFIC ST
OMAHA NE
68114-5298
US

V. Phone/Fax

Practice location:
  • Phone: 402-343-2624
  • Fax: 402-343-2608
Mailing address:
  • Phone: 402-343-2624
  • Fax: 402-343-2608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number114408
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: