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General NPI Number Information
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NPI Number | 1467896316
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Entity Type | Individual
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Provider Name | NICOLE RAE OLSEN LAC
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Gender | Female
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Dates
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Enumeration Date | 04/23/2013
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Last Update Date | 02/11/2026
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Provider Practice Location Address
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Address Line | 38 RONALD REAGAN BLVD
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City | WARWICK
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State | NY
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Zip | 10990-4106
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Country | US
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Telephone | 347-668-7175
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Fax |
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Provider Business Mailing Address
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Address Line | 10 SUNRISE DR UNIT 4
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City | VERNON
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State | NJ
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Zip | 07462-4518
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Country | US
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Telephone | 347-668-7175
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 25005040
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License Number State | NY
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