Provider Demographics
NPI:1952765372
Name:OLSON, JOANNA LINN (PA)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:LINN
Last Name:OLSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1684 FOOTE AVENUE EXT
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-9385
Mailing Address - Country:US
Mailing Address - Phone:716-661-9730
Mailing Address - Fax:716-661-9732
Practice Address - Street 1:1684 FOOTE AVENUE EXT
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-9385
Practice Address - Country:US
Practice Address - Phone:716-661-9730
Practice Address - Fax:716-661-9732
Is Sole Proprietor?:No
Enumeration Date:2016-04-12
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP01172363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP01172OtherNYS PERMIT