Provider Demographics
NPI:1578226338
Name:OLSEN, REBECCA LAUREN (DNP)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:LAUREN
Last Name:OLSEN
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:LAUREN
Other - Last Name:KUNKEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2112 HARRISBURG PIKE STE 200
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-2644
Mailing Address - Country:US
Mailing Address - Phone:717-544-3059
Mailing Address - Fax:717-544-3638
Practice Address - Street 1:2112 HARRISBURG PIKE STE 200
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-2644
Practice Address - Country:US
Practice Address - Phone:717-544-3059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-19
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN709196163W00000X
PASP024275363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse