Provider Demographics
NPI:1245063270
Name:OLSEN, NICHOLE (FNP)
Entity type:Individual
Prefix:
First Name:NICHOLE
Middle Name:
Last Name:OLSEN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2254 N 2850 W
Mailing Address - Street 2:
Mailing Address - City:PLAIN CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84404-9254
Mailing Address - Country:US
Mailing Address - Phone:801-430-8337
Mailing Address - Fax:
Practice Address - Street 1:7285 W 21200 N
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:UT
Practice Address - Zip Code:84330-7727
Practice Address - Country:US
Practice Address - Phone:435-458-9205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-23
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT348050-4405363LF0000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine