Provider Demographics
NPI:1710724620
Name:OLSEN, SAMUEL JOSEPH (PMHNP-APRN)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:JOSEPH
Last Name:OLSEN
Suffix:
Gender:M
Credentials:PMHNP-APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2673 RUSH RD
Mailing Address - Street 2:
Mailing Address - City:NORTON
Mailing Address - State:OH
Mailing Address - Zip Code:44203-4963
Mailing Address - Country:US
Mailing Address - Phone:330-414-9653
Mailing Address - Fax:
Practice Address - Street 1:2673 RUSH RD
Practice Address - Street 2:
Practice Address - City:NORTON
Practice Address - State:OH
Practice Address - Zip Code:44203-4963
Practice Address - Country:US
Practice Address - Phone:330-414-9653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0036895363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health