Healthcare Provider Details

I. General information

NPI: 1679485619
Provider Name (Legal Business Name): JENNIFER LYNN OLUFSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 W WASHINGTON AVE
BRUCE WI
54819-9641
US

IV. Provider business mailing address

104 W WASHINGTON AVE
BRUCE WI
54819-9641
US

V. Phone/Fax

Practice location:
  • Phone: 715-868-2585
  • Fax: 715-868-2534
Mailing address:
  • Phone: 715-868-2585
  • Fax: 715-868-2534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number84344-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: