Provider Demographics
NPI:1285233502
Name:OLSEN, MIKAELA MARIE (DNP, APRN-CNS, AOCNS)
Entity type:Individual
Prefix:DR
First Name:MIKAELA
Middle Name:MARIE
Last Name:OLSEN
Suffix:
Gender:F
Credentials:DNP, APRN-CNS, AOCNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6904 TIMBER CREEK CT
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21029-1748
Mailing Address - Country:US
Mailing Address - Phone:443-934-4480
Mailing Address - Fax:
Practice Address - Street 1:201 N BROADWAY ST RM 5228
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-0031
Practice Address - Country:US
Practice Address - Phone:410-614-6233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-19
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDCS00034364SX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SX0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistOncology