Provider Demographics
NPI:1295397446
Name:OLLIE, JOAN ANNETTE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:ANNETTE
Last Name:OLLIE
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:MRS
Other - First Name:JOAN
Other - Middle Name:
Other - Last Name:OLLIE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NURSE PRACTITIONER
Mailing Address - Street 1:4233 W 76TH ST APT 201
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60652-1244
Mailing Address - Country:US
Mailing Address - Phone:773-677-4092
Mailing Address - Fax:
Practice Address - Street 1:4233 W 76TH ST APT 201
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60652-1244
Practice Address - Country:US
Practice Address - Phone:773-677-4092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-08
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041260739163W00000X
IL209017595363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty