MEDICARE: NICHOLE OLSEN FNP

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	363LF0000X	Family Nurse Practitioner	348050-4405	UT
2	207Q00000X	Family Medicine Physician	348050-4405	UT

General Provider Information

NPI Number	:	1245063270
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLE OLSEN FNP

Provider Business Mailing Address
First Line	:	2254 N 2850 W
Second Line	:
City	:	PLAIN CITY
State	:	UT
Zip	:	84404-9254
Country	:	US
Telephone Number	:	801-430-8337
Fax Number	:

Provider Business Practice Location Address
First Line	:	7285 W 21200 N
Second Line	:
City	:	PLYMOUTH
State	:	UT
Zip	:	84330-7727
Country	:	US
Telephone Number	:	435-458-9205
Fax Number	:

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

Provider Enumeration Date	:	08/23/2024
Last Update Date	:	10/16/2024

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Directions to “ NICHOLE OLSEN FNP” Practice Location

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