Provider Demographics
NPI:1386272771
Name:LANNON, OLGA AGNIESZKA (FNP-C, CRNP)
Entity type:Individual
Prefix:MRS
First Name:OLGA
Middle Name:AGNIESZKA
Last Name:LANNON
Suffix:
Gender:F
Credentials:FNP-C, CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:927 MORGAN RUN RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLE RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:21220-2163
Mailing Address - Country:US
Mailing Address - Phone:410-530-2898
Mailing Address - Fax:
Practice Address - Street 1:3989 BOSTON ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-5759
Practice Address - Country:US
Practice Address - Phone:410-834-7547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-31
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95066082163W00000X
MDR209342363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse