Provider Demographics
NPI:1750927927
Name:OLSEN, BRADLEY JAMES (DNP)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:JAMES
Last Name:OLSEN
Suffix:
Gender:M
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1630 E 2450 S UNIT 95
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-7060
Mailing Address - Country:US
Mailing Address - Phone:480-528-0482
Mailing Address - Fax:
Practice Address - Street 1:1630 E 2450 S UNIT 95
Practice Address - Street 2:
Practice Address - City:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-7060
Practice Address - Country:US
Practice Address - Phone:480-528-0482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-22
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5613376-4405363LF0000X
AZ235004363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily