Provider Demographics
NPI:1871354696
Name:OLAVESON, ABAGAIL (APRN-CNP)
Entity type:Individual
Prefix:
First Name:ABAGAIL
Middle Name:
Last Name:OLAVESON
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:ABAGAIL
Other - Middle Name:
Other - Last Name:ERICKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:920 S RISING SUN DR STE 120
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-6000
Mailing Address - Country:US
Mailing Address - Phone:208-515-2273
Mailing Address - Fax:208-515-2274
Practice Address - Street 1:920 S RISING SUN DR STE 120
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83686-6000
Practice Address - Country:US
Practice Address - Phone:208-515-2273
Practice Address - Fax:208-515-2274
Is Sole Proprietor?:No
Enumeration Date:2024-01-18
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID55750163WC0200X
390200000X
ID9961773363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program