Provider Demographics
NPI:1134697972
Name:OLSON, ANDREA A (RN)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:A
Last Name:OLSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:ANDREA
Other - Middle Name:ANN
Other - Last Name:ATKINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1020 N APPLETON ST
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-4403
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1020 N APPLETON ST
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-4403
Practice Address - Country:US
Practice Address - Phone:920-266-6999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-09
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI17782130163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse