Provider Demographics
NPI:1326592569
Name:OLESON, ELIZABETH CRETTI (AGNP-BC)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:CRETTI
Last Name:OLESON
Suffix:
Gender:F
Credentials:AGNP-BC
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:JANE
Other - Last Name:CRETTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1010 COLUMBIA PL
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-2316
Mailing Address - Country:US
Mailing Address - Phone:650-468-3026
Mailing Address - Fax:
Practice Address - Street 1:1 SHIELDS AVE
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-5200
Practice Address - Country:US
Practice Address - Phone:530-752-6475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-04
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA804180163W00000X
CA95005173363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163W00000XNursing Service ProvidersRegistered Nurse