Healthcare Provider Details

I. General information

NPI: 1871515122
Provider Name (Legal Business Name): LISA ANN OLSON APNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 08/23/2020
Certification Date: 08/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1617 SHERMAN AVE
MADISON WI
53704-5930
US

IV. Provider business mailing address

1617 SHERMAN AVE
MADISON WI
53704-5930
US

V. Phone/Fax

Practice location:
  • Phone: 608-240-0035
  • Fax:
Mailing address:
  • Phone: 608-240-0035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number130377-030
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number4803-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: