Provider Demographics
NPI:1013172790
Name:OLESEN, ANDREW (APRN)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:OLESEN
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:ANDREW
Other - Middle Name:
Other - Last Name:OLESEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DHA, NP
Mailing Address - Street 1:922 NOB HILL AVE
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:922 NOB HILL AVE
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003
Practice Address - Country:US
Practice Address - Phone:801-471-0951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-22
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT48654954405363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVUSA000683789OtherUSMM MARINE PHYSICIAN ASSISTANT