Individual
JEANNE E OLSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
7401 104TH AVE STE 110, KENOSHA, WI 53142-7845
(262) 764-5595
(262) 764-9314
Mailing address
7401 104TH AVE STE 110, KENOSHA, WI 53142-7845
(262) 764-5595
(262) 764-9314
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
3648-23
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100047666
—
WI
Enumeration date
08/27/2015
Last updated
11/02/2021
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