Provider Demographics
NPI:1255859419
Name:OLSEN, JOANNA (FNP-BC)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:OLSEN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:JOANNA
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2280 S. 11TH ST.
Mailing Address - Street 2:SUITE 100
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-0103
Mailing Address - Country:US
Mailing Address - Phone:269-263-2573
Mailing Address - Fax:833-941-2003
Practice Address - Street 1:2280 S. 11TH ST.
Practice Address - Street 2:SUITE 100
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-0103
Practice Address - Country:US
Practice Address - Phone:269-263-2573
Practice Address - Fax:833-941-2003
Is Sole Proprietor?:No
Enumeration Date:2017-09-07
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704221484363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily