Provider Demographics
NPI:1104807619
Name:OLSON, JANICE L (NP FAMILY)
Entity type:Individual
Prefix:MS
First Name:JANICE
Middle Name:L
Last Name:OLSON
Suffix:
Gender:F
Credentials:NP FAMILY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 STRATTON DR
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92083-4778
Mailing Address - Country:US
Mailing Address - Phone:760-221-4823
Mailing Address - Fax:
Practice Address - Street 1:6973 LINDA VISTA RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-6339
Practice Address - Country:US
Practice Address - Phone:858-279-9676
Practice Address - Fax:858-279-0377
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAFNP7509363L00000X, 363LF0000X
CARN306836363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
S52141Medicare UPIN
CAWNP7509AMedicare ID - Type UnspecifiedPPIN
CABI617ZMedicare UPIN