Basic Information
| Provider Information | |||||||||
| NPI: | 1821229154 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OLSEN | ||||||||
| FirstName: | ABBY | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | ANP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 363 FREMONT ST | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | BATTLE CREEK | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490173389 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2699696123 | ||||||||
| FaxNumber: | 2699696122 | ||||||||
| Practice Location | |||||||||
| Address1: | 363 FREMONT ST | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | BATTLE CREEK | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490173389 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2699696123 | ||||||||
| FaxNumber: | 2699696122 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2009 | ||||||||
| LastUpdateDate: | 10/19/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WC1500X | 4704261671 | MI | N | Nursing Service Providers | Registered Nurse | Community Health | 207Q00000X | 207Q000000X | MI | N | Allopathic & Osteopathic Physicians | Family Medicine | 363LA2200X | 4704261671 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
ID Information
| ID | Type | State | Issuer | Description | 4704261671 | 01 | MI | STATE LICENSE | OTHER |