Provider Demographics
NPI:1790469690
Name:OLESEN, MARISA JOY (DNP, APRN, FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:MARISA
Middle Name:JOY
Last Name:OLESEN
Suffix:
Gender:F
Credentials:DNP, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 46TH AVE SE STE 204
Mailing Address - Street 2:
Mailing Address - City:MANDAN
Mailing Address - State:ND
Mailing Address - Zip Code:58554-4829
Mailing Address - Country:US
Mailing Address - Phone:701-471-6553
Mailing Address - Fax:
Practice Address - Street 1:2401 46TH AVE SE STE 204
Practice Address - Street 2:
Practice Address - City:MANDAN
Practice Address - State:ND
Practice Address - Zip Code:58554-4829
Practice Address - Country:US
Practice Address - Phone:844-397-5867
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR33369363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily