Healthcare Provider Details

I. General information

NPI: 1245817097
Provider Name (Legal Business Name): JAYNA LUNDE OLSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JAYNA LUNDE SCHULTZ

II. Dates (important events)

Enumeration Date: 03/26/2021
Last Update Date: 03/26/2021
Certification Date: 03/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 GRIFFIN ST E
AMERY WI
54001-1439
US

IV. Provider business mailing address

265 GRIFFIN ST E
AMERY WI
54001-1439
US

V. Phone/Fax

Practice location:
  • Phone: 715-268-8000
  • Fax:
Mailing address:
  • Phone: 715-268-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10749-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: