Healthcare Provider Details

I. General information

NPI: 1154105500
Provider Name (Legal Business Name): JOHN THOMAS OLSTAD PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2023
Last Update Date: 09/27/2026
Certification Date: 09/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 W VLIET ST
MILWAUKEE WI
53208-2120
US

IV. Provider business mailing address

1433 E OKLAHOMA AVE
MILWAUKEE WI
53207-2430
US

V. Phone/Fax

Practice location:
  • Phone: 414-928-1414
  • Fax: 414-928-1415
Mailing address:
  • Phone: 414-928-1414
  • Fax: 414-928-1415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number14294-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: