Provider Demographics
NPI:1609235688
Name:OLSEN, SEAN LUCIEN (DNP)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:LUCIEN
Last Name:OLSEN
Suffix:
Gender:M
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MANTI
Mailing Address - State:UT
Mailing Address - Zip Code:84642-1254
Mailing Address - Country:US
Mailing Address - Phone:435-835-7246
Mailing Address - Fax:435-835-7247
Practice Address - Street 1:46 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MANTI
Practice Address - State:UT
Practice Address - Zip Code:84642-1254
Practice Address - Country:US
Practice Address - Phone:435-835-7246
Practice Address - Fax:435-835-7247
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-18
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6898945-4405363LF0000X
WY41018.1704363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily