Provider Demographics
NPI:1821639543
Name:OLSEM, LISA ANNE
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANNE
Last Name:OLSEM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2360 COTTAGE DR APT 56
Mailing Address - Street 2:
Mailing Address - City:N SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55109-7270
Mailing Address - Country:US
Mailing Address - Phone:651-200-5531
Mailing Address - Fax:
Practice Address - Street 1:2360 COTTAGE DR APT 56
Practice Address - Street 2:
Practice Address - City:N SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55109-7270
Practice Address - Country:US
Practice Address - Phone:651-200-5531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-03
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider