Provider Demographics
NPI:1912542051
Name:OLSEN, STEPHANIE A (APRN)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:A
Last Name:OLSEN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3051 HOLLIS DR FL 2
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-7452
Mailing Address - Country:US
Mailing Address - Phone:217-523-5432
Mailing Address - Fax:217-492-9643
Practice Address - Street 1:300 SATTLEY ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:IL
Practice Address - Zip Code:62563-9241
Practice Address - Country:US
Practice Address - Phone:217-789-3630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-13
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209020211363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner