MEDICARE: CHARLES OLSEN NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WP0808X	Psychiatric/Mental Health Registered Nurse	20065	TN

General Provider Information

NPI Number	:	1053795518
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES OLSEN NP

Provider Business Mailing Address
First Line	:	63 TAYLOR AVE
Second Line	:
City	:	CROSSVILLE
State	:	TN
Zip	:	38555-4567
Country	:	US
Telephone Number	:	931-250-5488
Fax Number	:	931-250-5667

Provider Business Practice Location Address
First Line	:	63 TAYLOR AVE
Second Line	:
City	:	CROSSVILLE
State	:	TN
Zip	:	38555-4567
Country	:	US
Telephone Number	:	931-250-5488
Fax Number	:	931-250-5667

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/15/2015
Last Update Date	:	12/09/2024

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