Provider Demographics
NPI:1508680448
Name:NAIRN, OLIVIA (APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:NAIRN
Suffix:
Gender:
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 MAPLE SUMMIT RD
Mailing Address - Street 2:
Mailing Address - City:JERSEYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62052-2000
Mailing Address - Country:US
Mailing Address - Phone:618-498-2101
Mailing Address - Fax:618-498-8153
Practice Address - Street 1:390 MAPLE SUMMIT RD
Practice Address - Street 2:
Practice Address - City:JERSEYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62052-2000
Practice Address - Country:US
Practice Address - Phone:618-498-2101
Practice Address - Fax:618-498-8153
Is Sole Proprietor?:No
Enumeration Date:2024-11-07
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209031157363LF0000X
IL041502607163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL16379882OtherCAQH ID