Provider Demographics
NPI:1609522218
Name:OLMSTED, BRIANNE NICOLE (NP)
Entity type:Individual
Prefix:MRS
First Name:BRIANNE
Middle Name:NICOLE
Last Name:OLMSTED
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:BRIANNE
Other - Middle Name:NICOLE
Other - Last Name:GLEAVE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1625 WOLF CIRCLE
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605
Mailing Address - Country:US
Mailing Address - Phone:337-905-7100
Mailing Address - Fax:337-905-7101
Practice Address - Street 1:1625 WOLF CIRCLE
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605
Practice Address - Country:US
Practice Address - Phone:337-905-7100
Practice Address - Fax:337-905-7101
Is Sole Proprietor?:No
Enumeration Date:2022-02-23
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA224271363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily