Provider Demographics
NPI:1578198420
Name:OLSON, JESSICA ASHLEY (APN, FNP-C)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ASHLEY
Last Name:OLSON
Suffix:
Gender:F
Credentials:APN, FNP-C
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:WARGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2527 FOX TROT TRL
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61705-6603
Mailing Address - Country:US
Mailing Address - Phone:309-846-5866
Mailing Address - Fax:
Practice Address - Street 1:1603 VISA DR
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-2131
Practice Address - Country:US
Practice Address - Phone:309-268-9000
Practice Address - Fax:309-268-9003
Is Sole Proprietor?:No
Enumeration Date:2020-03-10
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.020800363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner