Provider Demographics
NPI:1083871073
Name:OLSON, DIANNE M (RN, PNP)
Entity Type:Individual
Prefix:PROF
First Name:DIANNE
Middle Name:M
Last Name:OLSON
Suffix:
Gender:F
Credentials:RN, PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15715 S 46TH ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-0438
Mailing Address - Country:US
Mailing Address - Phone:480-496-6444
Mailing Address - Fax:480-496-9688
Practice Address - Street 1:15715 S 46TH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-0438
Practice Address - Country:US
Practice Address - Phone:480-496-6444
Practice Address - Fax:480-496-9688
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ02633363LP0200X
AZ63364SP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No364SP0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZT24172Medicare UPIN