Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 7292 | MN |
NPI | 1225663768 |
---|---|
Provider Name | Mrs. Amanda Elizabeth Olsen |
First Address | Scotch Plains, NJ 07076-4506 |
Second Address | Minneapolis, MN 55404-4518 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2020 |
Last Update Date | 05/03/2020 |