MEDICARE: NICOLE RAE OLSEN LAC

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	171100000X	Acupuncturist	25005040	NY

General Provider Information

NPI Number	:	1467896316
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE RAE OLSEN LAC

Provider Business Mailing Address
First Line	:	10 SUNRISE DR UNIT 4
Second Line	:
City	:	VERNON
State	:	NJ
Zip	:	07462-4518
Country	:	US
Telephone Number	:	347-668-7175
Fax Number	:

Provider Business Practice Location Address
First Line	:	38 RONALD REAGAN BLVD
Second Line	:
City	:	WARWICK
State	:	NY
Zip	:	10990-4106
Country	:	US
Telephone Number	:	347-668-7175
Fax Number	:

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

Provider Enumeration Date	:	04/23/2013
Last Update Date	:	02/11/2026

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