Provider Demographics
NPI:1568701043
Name:OLSON, CHRISTINA (ANP-BC)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:
Last Name:OLSON
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:MS
Other - First Name:CHRISTINA
Other - Middle Name:
Other - Last Name:MUTSCHLECHNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ANP-BC
Mailing Address - Street 1:2890 LINEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54313-7202
Mailing Address - Country:US
Mailing Address - Phone:920-662-2100
Mailing Address - Fax:
Practice Address - Street 1:2890 LINEVILLE RD
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54313
Practice Address - Country:US
Practice Address - Phone:920-662-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-04
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5179-33363LA2200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1568701043Medicaid