Provider Demographics
NPI:1093199804
Name:OLSSON, JEREMY D (MS, FNP-C)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:D
Last Name:OLSSON
Suffix:
Gender:M
Credentials:MS, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 OLD ROLLINSFORD RD
Mailing Address - Street 2:SUITE #5
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-2833
Mailing Address - Country:US
Mailing Address - Phone:603-742-4048
Mailing Address - Fax:
Practice Address - Street 1:1245 ELM ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03101-1308
Practice Address - Country:US
Practice Address - Phone:603-626-9500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-13
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH058882-23363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3101818Medicaid