Provider Demographics
NPI:1134558588
Name:OLBERG, VIRGEANA X (RN)
Entity type:Individual
Prefix:MS
First Name:VIRGEANA
Middle Name:
Last Name:OLBERG
Suffix:X
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 S 12TH ST
Mailing Address - Street 2:SUITE 4710
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-1004
Mailing Address - Country:US
Mailing Address - Phone:612-348-4437
Mailing Address - Fax:612-632-8593
Practice Address - Street 1:330 S 12TH ST
Practice Address - Street 2:SUITE 4710
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-1004
Practice Address - Country:US
Practice Address - Phone:612-348-4437
Practice Address - Fax:612-632-8593
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-06
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 79285-5163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health