Provider Demographics
NPI:1376759670
Name:OLSON, FAYE J (RN)
Entity Type:Individual
Prefix:
First Name:FAYE
Middle Name:J
Last Name:OLSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 2ND ST NE
Mailing Address - Street 2:
Mailing Address - City:NEW PHILADELPHIA
Mailing Address - State:OH
Mailing Address - Zip Code:44663-2808
Mailing Address - Country:US
Mailing Address - Phone:234-801-2469
Mailing Address - Fax:330-364-9212
Practice Address - Street 1:204 2ND ST NE
Practice Address - Street 2:
Practice Address - City:NEW PHILADELPHIA
Practice Address - State:OH
Practice Address - Zip Code:44663-2808
Practice Address - Country:US
Practice Address - Phone:234-801-2469
Practice Address - Fax:330-364-9212
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
OHRN. 162564163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH162564OtherLICENSE