Provider Demographics
NPI:1790294205
Name:OLSON, BRANDI LEANNE (FNP-C)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:LEANNE
Last Name:OLSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 KACHINA DR
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81008-1574
Mailing Address - Country:US
Mailing Address - Phone:719-569-4770
Mailing Address - Fax:563-334-8474
Practice Address - Street 1:2501 KACHINA DR
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-1574
Practice Address - Country:US
Practice Address - Phone:719-569-4770
Practice Address - Fax:563-334-8474
Is Sole Proprietor?:No
Enumeration Date:2017-09-27
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0993510-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily