Provider Demographics
NPI:1629304639
Name:OLSON, JANET KAY (APN)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:KAY
Last Name:OLSON
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11022 S 51ST ST STE 101
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-1789
Mailing Address - Country:US
Mailing Address - Phone:708-308-0852
Mailing Address - Fax:480-383-6371
Practice Address - Street 1:11022 S 51ST ST STE 101
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044
Practice Address - Country:US
Practice Address - Phone:708-308-0852
Practice Address - Fax:480-383-6371
Is Sole Proprietor?:No
Enumeration Date:2009-10-26
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209007853363LN0000X, 363LN0005X
AZAP7656363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
No363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care