1609522218 NPI number — MRS. BRIANNE NICOLE OLMSTED NP

Table of content: MRS. BRIANNE NICOLE OLMSTED NP (NPI 1609522218)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609522218 NPI number — MRS. BRIANNE NICOLE OLMSTED NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OLMSTED
Provider First Name:
BRIANNE
Provider Middle Name:
NICOLE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GLEAVE
Provider Other First Name:
BRIANNE
Provider Other Middle Name:
NICOLE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1609522218
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/23/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1625 WOLF CIRCLE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKE CHARLES
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70605
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-905-7100
Provider Business Mailing Address Fax Number:
337-905-7101

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1625 WOLF CIRCLE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE CHARLES
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-905-7100
Provider Business Practice Location Address Fax Number:
337-905-7101
Provider Enumeration Date:
02/23/2022

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  224271 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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