Healthcare Provider Details

I. General information

NPI: 1205494135
Provider Name (Legal Business Name): LAUREL OLSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2019
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7404 5TH AVE
BROOKLYN NY
11209-2704
US

IV. Provider business mailing address

968 60TH ST APT 210
BROOKLYN NY
11219-4857
US

V. Phone/Fax

Practice location:
  • Phone: 718-439-5111
  • Fax:
Mailing address:
  • Phone: 612-385-8908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number2018077032
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number641891
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number26NR21490800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: