Provider Demographics
NPI:1235502725
Name:OLAN, ELSA SOPHIA (APN)
Entity Type:Individual
Prefix:
First Name:ELSA
Middle Name:SOPHIA
Last Name:OLAN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:ELSA
Other - Middle Name:
Other - Last Name:TEMPLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:11 QUARRY CT
Mailing Address - Street 2:
Mailing Address - City:EAST WINDSOR
Mailing Address - State:NJ
Mailing Address - Zip Code:08520-3034
Mailing Address - Country:US
Mailing Address - Phone:201-310-7614
Mailing Address - Fax:
Practice Address - Street 1:1544 KUSER RD STE C1
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08619-3830
Practice Address - Country:US
Practice Address - Phone:609-585-3640
Practice Address - Fax:609-585-3640
Is Sole Proprietor?:No
Enumeration Date:2015-11-05
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00592800363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0538825Medicaid