Provider Demographics
NPI:1215089883
Name:OLSEN, AJONA DAMGAARD (ANP)
Entity type:Individual
Prefix:
First Name:AJONA
Middle Name:DAMGAARD
Last Name:OLSEN
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2655 W OAKGROVE LN
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-7861
Mailing Address - Country:US
Mailing Address - Phone:480-215-0211
Mailing Address - Fax:
Practice Address - Street 1:3003 N CENTRAL AVE STE 800
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-2946
Practice Address - Country:US
Practice Address - Phone:480-215-0211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP2411363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health