Provider Demographics
NPI:1609414010
Name:OLSON, NICOLE LINETTE (ARNP)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:LINETTE
Last Name:OLSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4480 UTICA RIDGE RD STE 1140
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-1644
Mailing Address - Country:US
Mailing Address - Phone:563-742-5700
Mailing Address - Fax:563-742-5705
Practice Address - Street 1:4480 UTICA RIDGE RD STE 1140
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-1644
Practice Address - Country:US
Practice Address - Phone:563-742-5700
Practice Address - Fax:563-742-5705
Is Sole Proprietor?:No
Enumeration Date:2019-12-16
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA157325363LF0000X, 363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily