Provider Demographics
NPI:1386199511
Name:OLESEN, JENNIFER LEEANN (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LEEANN
Last Name:OLESEN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:917 1ST ST
Mailing Address - Street 2:
Mailing Address - City:LA SALLE
Mailing Address - State:IL
Mailing Address - Zip Code:61301-2537
Mailing Address - Country:US
Mailing Address - Phone:815-780-2525
Mailing Address - Fax:949-655-5957
Practice Address - Street 1:917 1ST ST
Practice Address - Street 2:
Practice Address - City:LA SALLE
Practice Address - State:IL
Practice Address - Zip Code:61301-2537
Practice Address - Country:US
Practice Address - Phone:815-780-2525
Practice Address - Fax:949-655-5957
Is Sole Proprietor?:No
Enumeration Date:2016-08-17
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209014689363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily