Provider Demographics
NPI:1023442357
Name:OLSEN, TONYA LYNN (RN)
Entity type:Individual
Prefix:
First Name:TONYA
Middle Name:LYNN
Last Name:OLSEN
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:PO BOX 1498
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:OK
Mailing Address - Zip Code:74355-1498
Mailing Address - Country:US
Mailing Address - Phone:918-542-1655
Mailing Address - Fax:918-540-1685
Practice Address - Street 1:7600 S HIGHWAY 69A
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:OK
Practice Address - Zip Code:74354-1016
Practice Address - Country:US
Practice Address - Phone:918-542-1655
Practice Address - Fax:918-540-1685
Is Sole Proprietor?:No
Enumeration Date:2013-08-22
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0060379163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse