Healthcare Provider Details

I. General information

NPI: 1205652229
Provider Name (Legal Business Name): NICOLE OLBRICH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2024
Last Update Date: 11/25/2024
Certification Date: 11/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7400 W RAWSON AVE
FRANKLIN WI
53132-8278
US

IV. Provider business mailing address

4147 N FARWELL AVE
SHOREWOOD WI
53211-1754
US

V. Phone/Fax

Practice location:
  • Phone: 414-425-7000
  • Fax:
Mailing address:
  • Phone: 317-709-4852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number16179-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: