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NPI Code Detail

MEDICARE: STEPHANIE A OLSEN APRN

MEDICARE:   STEPHANIE A OLSEN  APRN
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
1363L00000XNurse Practitioner209020211IL

General Provider Information

NPI Number : 1912542051
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHANIE A OLSEN APRN
Provider Business Mailing Address
First Line : 3051 HOLLIS DR FL 2
Second Line :
City : SPRINGFIELD
State : IL
Zip : 62704-7452
Country : US
Telephone Number : 217-523-5432
Fax Number : 217-492-9643
Provider Business Practice Location Address
First Line : 300 SATTLEY ST
Second Line :
City : ROCHESTER
State : IL
Zip : 62563-9241
Country : US
Telephone Number : 217-789-3630
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/13/2019
Last Update Date : 01/06/2022

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Directions to “ STEPHANIE A OLSEN APRN” Practice Location

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