Provider Demographics
NPI:1912083114
Name:OLEAR, JOAN M (NP)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:M
Last Name:OLEAR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30170 23 MILE RD
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48047-2190
Mailing Address - Country:US
Mailing Address - Phone:586-949-5900
Mailing Address - Fax:586-949-5922
Practice Address - Street 1:21300 KELLY ROAD
Practice Address - Street 2:
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021
Practice Address - Country:US
Practice Address - Phone:586-447-4200
Practice Address - Fax:586-447-4208
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704140670363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
S84099Medicare UPIN