Provider Demographics
NPI:1689720997
Name:OLSEN, CHRISTINE M (LPN)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:M
Last Name:OLSEN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8713 W ELMORE AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53222-2842
Mailing Address - Country:US
Mailing Address - Phone:414-466-7751
Mailing Address - Fax:
Practice Address - Street 1:8713 W ELMORE AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53222-2842
Practice Address - Country:US
Practice Address - Phone:414-466-7751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16300-031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39954000Medicaid