Provider Demographics
NPI:1275688053
Name:OLSSON, MONIKA E (NP)
Entity Type:Individual
Prefix:MS
First Name:MONIKA
Middle Name:E
Last Name:OLSSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:729 MASSACHUSETTS AVE
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2318
Mailing Address - Country:US
Mailing Address - Phone:617-414-7779
Mailing Address - Fax:617-414-7776
Practice Address - Street 1:729 MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2318
Practice Address - Country:US
Practice Address - Phone:617-414-7779
Practice Address - Fax:617-414-7776
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA271185363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner