Provider Demographics
NPI:1558340885
Name:OLSON, JEANINE RAE (NP)
Entity Type:Individual
Prefix:MS
First Name:JEANINE
Middle Name:RAE
Last Name:OLSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30958 SW SALMON LN
Mailing Address - Street 2:
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-9790
Mailing Address - Country:US
Mailing Address - Phone:503-320-7722
Mailing Address - Fax:
Practice Address - Street 1:25749 SW CANYON CREEK RD
Practice Address - Street 2:SUITE 600
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-6629
Practice Address - Country:US
Practice Address - Phone:503-486-1022
Practice Address - Fax:503-682-7596
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR080046255N3-ANP-PP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health