Provider Demographics
NPI:1740583863
Name:OLSON, JODI M (ACNP)
Entity type:Individual
Prefix:MS
First Name:JODI
Middle Name:M
Last Name:OLSON
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10730 S 1120 E
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84094-5091
Mailing Address - Country:US
Mailing Address - Phone:801-685-7700
Mailing Address - Fax:
Practice Address - Street 1:308 E 4500 S STE 175
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-3977
Practice Address - Country:US
Practice Address - Phone:801-685-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-11
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT198921-3102363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care