Healthcare Provider Details

I. General information

NPI: 1699603290
Provider Name (Legal Business Name): MELISSA OLSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 07/25/2026
Certification Date: 07/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 S STATE ST
SALT LAKE CITY UT
84111-1401
US

IV. Provider business mailing address

36 S STATE ST
SALT LAKE CITY UT
84111-1401
US

V. Phone/Fax

Practice location:
  • Phone: 801-442-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number408920
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number11307611-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: