Provider Demographics
NPI:1891336863
Name:OLSON, JESSE ELAINE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:ELAINE
Last Name:OLSON
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 RIVER TERRACE CT APT 105
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-3711
Mailing Address - Country:US
Mailing Address - Phone:320-250-3997
Mailing Address - Fax:
Practice Address - Street 1:6601 LYNDALE AVE S
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55423-2477
Practice Address - Country:US
Practice Address - Phone:612-823-8001
Practice Address - Fax:612-823-1010
Is Sole Proprietor?:No
Enumeration Date:2019-10-01
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6424363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health