Provider Demographics
NPI:1871515122
Name:OLSON, LISA ANN (APNP-BC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:OLSON
Suffix:
Gender:F
Credentials:APNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1617 SHERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-5930
Mailing Address - Country:US
Mailing Address - Phone:608-240-0035
Mailing Address - Fax:
Practice Address - Street 1:1617 SHERMAN AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-5930
Practice Address - Country:US
Practice Address - Phone:608-240-0035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2020-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI130377-030163W00000X
WI4803-33363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse