Provider Demographics
NPI:1194232355
Name:OLSON, REBECCA NICHOLE (LPN)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:NICHOLE
Last Name:OLSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 COLE AVE
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-8061
Mailing Address - Country:US
Mailing Address - Phone:716-485-1961
Mailing Address - Fax:
Practice Address - Street 1:411 W 3RD ST
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-4801
Practice Address - Country:US
Practice Address - Phone:716-487-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-09
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY300350-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse