Provider Demographics
NPI:1457118168
Name:PAWLENKO-OLSEN, DEANA BETH
Entity Type:Individual
Prefix:
First Name:DEANA
Middle Name:BETH
Last Name:PAWLENKO-OLSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2636 ELM HILL PIKE STE 120
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37214-3162
Mailing Address - Country:US
Mailing Address - Phone:615-730-9944
Mailing Address - Fax:
Practice Address - Street 1:2636 ELM HILL PIKE STE 120
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37214-3162
Practice Address - Country:US
Practice Address - Phone:516-732-9825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-29
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY353320363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily