Healthcare Provider Details

I. General information

NPI: 1285752477
Provider Name (Legal Business Name): CHRISTIE LEE OLSEN FOUNDER-NURSE PRACTI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 10/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 PRICE PLACE #108
MADISON WI
53705
US

IV. Provider business mailing address

313 PRICE PLACE #108
MADISON WI
53705
US

V. Phone/Fax

Practice location:
  • Phone: 608-217-7511
  • Fax: 608-234-5994
Mailing address:
  • Phone: 608-217-7511
  • Fax: 608-234-5994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number140915-030
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number2162-033
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number33-2162
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: