Provider Demographics
NPI:1750923967
Name:OLESEN, JESSIE LEA (FNP)
Entity type:Individual
Prefix:
First Name:JESSIE
Middle Name:LEA
Last Name:OLESEN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74185 ROAD 436
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:NE
Mailing Address - Zip Code:68976-1046
Mailing Address - Country:US
Mailing Address - Phone:308-991-7334
Mailing Address - Fax:
Practice Address - Street 1:74185 ROAD 436
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:NE
Practice Address - Zip Code:68976-1046
Practice Address - Country:US
Practice Address - Phone:308-991-7334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-09
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE112985363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily