Healthcare Provider Details

I. General information

NPI: 1538746847
Provider Name (Legal Business Name): GERILYN OLSEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2021
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13800 W NORTH AVE STE 100
BROOKFIELD WI
53005-4977
US

IV. Provider business mailing address

13800 W NORTH AVE STE 100
BROOKFIELD WI
53005-4977
US

V. Phone/Fax

Practice location:
  • Phone: 262-754-4488
  • Fax: 262-754-4940
Mailing address:
  • Phone: 262-754-4488
  • Fax: 262-754-4940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number1021464
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: