Provider Demographics
NPI:1841298320
Name:OLSRUD, MELANIE M (FNP)
Entity type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:M
Last Name:OLSRUD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MISS
Other - First Name:MELANIE
Other - Middle Name:M
Other - Last Name:TURNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:1075 GRANDVIEW AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97527-5118
Mailing Address - Country:US
Mailing Address - Phone:541-479-8363
Mailing Address - Fax:
Practice Address - Street 1:1075 SW GRANDVIEW AVENUE
Practice Address - Street 2:SUITE 200
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97527
Practice Address - Country:US
Practice Address - Phone:541-479-8363
Practice Address - Fax:541-476-2841
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200550041363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR270068Medicaid
ORP66845Medicare UPIN
OR270068Medicaid