Provider Demographics
NPI:1497352314
Name:OLSON, LISA ANN (RN, MN)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:ANN
Last Name:OLSON
Suffix:
Gender:F
Credentials:RN, MN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10940 VIA BOLOGNA APT 2910
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-1681
Mailing Address - Country:US
Mailing Address - Phone:608-354-3841
Mailing Address - Fax:
Practice Address - Street 1:1255 IMPERIAL AVE STE 740
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-7493
Practice Address - Country:US
Practice Address - Phone:619-551-8589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-04
Last Update Date:2020-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA204746163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse