Healthcare Provider Details

I. General information

NPI: 1528669454
Provider Name (Legal Business Name): JANA OLNEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2020
Last Update Date: 11/06/2020
Certification Date: 11/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 E 1300 N
LOGAN UT
84341-2570
US

IV. Provider business mailing address

655 E 1300 N
LOGAN UT
84341-2570
US

V. Phone/Fax

Practice location:
  • Phone: 435-792-6500
  • Fax:
Mailing address:
  • Phone: 435-792-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number6256275-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: