=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538746847
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GERILYN OLSEN MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/24/2021
-----------------------------------------------------
Last Update Date | 06/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 330 BROOKLINE AVE # 522
-----------------------------------------------------
City | BOSTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02215-5400
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-667-4995
-----------------------------------------------------
Fax | 617-667-4948
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 999 N 92ND ST STE 730
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53226-4875
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-266-6800
-----------------------------------------------------
Fax | 414-337-7068
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207N00000X
-----------------------------------------------------
Taxonomy Name | Dermatology Physician
-----------------------------------------------------
License Number | 1021464
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------