Healthcare Provider Details

I. General information

NPI: 1538935903
Provider Name (Legal Business Name): ALEXANDRA LEE OLSEN AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2023
Last Update Date: 01/02/2024
Certification Date: 01/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 N GEORGE MASON DR
ARLINGTON VA
22205-3610
US

IV. Provider business mailing address

2500 CLARENDON BLVD APT 425
ARLINGTON VA
22201-3828
US

V. Phone/Fax

Practice location:
  • Phone: 703-521-6662
  • Fax:
Mailing address:
  • Phone: 518-368-3005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number0024188939
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberNP1053038
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: