Provider Demographics
NPI:1629891130
Name:WU, OLESYA JOHANNA (CRNP)
Entity type:Individual
Prefix:
First Name:OLESYA
Middle Name:JOHANNA
Last Name:WU
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:OLESYA
Other - Middle Name:JOHANNA
Other - Last Name:TRIKUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3400 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-4238
Mailing Address - Country:US
Mailing Address - Phone:215-378-4876
Mailing Address - Fax:
Practice Address - Street 1:3400 SPRUCE ST
Practice Address - Street 2:2 DULLES
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4238
Practice Address - Country:US
Practice Address - Phone:215-662-7320
Practice Address - Fax:215-349-5917
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-04
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP029986363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Multi-Specialty