Healthcare Provider Details

I. General information

NPI: 1679440606
Provider Name (Legal Business Name): BROOKLYNN MARIE OLSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2025
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 E SECOND ST
RICHLAND CENTER WI
53581
US

IV. Provider business mailing address

110 S MAPLE ST
LA FARGE WI
54639
US

V. Phone/Fax

Practice location:
  • Phone: 608-647-6161
  • Fax:
Mailing address:
  • Phone: 608-604-9533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1105864-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: