Provider Demographics
NPI:1861130320
Name:OLMSTEAD, ELIZABETH A (RN)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:OLMSTEAD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 FOX RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:NC
Mailing Address - Zip Code:28398-9588
Mailing Address - Country:US
Mailing Address - Phone:309-678-3470
Mailing Address - Fax:
Practice Address - Street 1:308 FOX RIDGE RD
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:NC
Practice Address - Zip Code:28398-9588
Practice Address - Country:US
Practice Address - Phone:309-678-3470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-24
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704363047163W00000X
NC323012163WD0400X, 163W00000X
IL041376043163WG0000X
171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No171400000XOther Service ProvidersHealth & Wellness Coach