Provider Demographics
NPI:1861574923
Name:OLSON, BRENDA LEE (LVN)
Entity type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:LEE
Last Name:OLSON
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:MS
Other - First Name:BRENDA
Other - Middle Name:LEE
Other - Last Name:VALENTINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LVN
Mailing Address - Street 1:1381 HUGGINS AVE
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-2914
Mailing Address - Country:US
Mailing Address - Phone:530-892-8106
Mailing Address - Fax:530-892-8106
Practice Address - Street 1:1381 HUGGINS AVE
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-2914
Practice Address - Country:US
Practice Address - Phone:530-892-8106
Practice Address - Fax:530-892-8106
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN165591164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARVN002360Medicaid
CAEPS014000Medicaid