Healthcare Provider Details

I. General information

NPI: 1578226338
Provider Name (Legal Business Name): REBECCA LAUREN OLSEN DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA LAUREN KUNKEL

II. Dates (important events)

Enumeration Date: 10/19/2021
Last Update Date: 11/29/2023
Certification Date: 11/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2112 HARRISBURG PIKE STE 200
LANCASTER PA
17601-2644
US

IV. Provider business mailing address

2112 HARRISBURG PIKE STE 200
LANCASTER PA
17601-2644
US

V. Phone/Fax

Practice location:
  • Phone: 717-544-3059
  • Fax:
Mailing address:
  • Phone: 717-544-3059
  • Fax: 717-544-3638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP024275
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN709196
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: