MEDICARE: JENNA CHRISTINE OLSON RN

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	163WH0200X	Home Health Registered Nurse	176816-30	WI

General Provider Information

NPI Number	:	1376209346
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNA CHRISTINE OLSON RN

Provider Business Mailing Address
First Line	:	W1424 N BLOOMFIELD RD
Second Line	:
City	:	LAKE GENEVA
State	:	WI
Zip	:	53147-4428
Country	:	US
Telephone Number	:	262-903-9759
Fax Number	:

Provider Business Practice Location Address
First Line	:	W1424 N BLOOMFIELD RD
Second Line	:
City	:	LAKE GENEVA
State	:	WI
Zip	:	53147-4428
Country	:	US
Telephone Number	:	262-903-9759
Fax Number	:

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

Provider Enumeration Date	:	11/12/2021
Last Update Date	:	11/12/2021

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