Provider Demographics
NPI:1679385603
Name:OLMSTEAD, JONATHON ERVIN (RN)
Entity type:Individual
Prefix:MR
First Name:JONATHON
Middle Name:ERVIN
Last Name:OLMSTEAD
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:339 S KENNETH PL
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-4645
Mailing Address - Country:US
Mailing Address - Phone:480-766-9342
Mailing Address - Fax:
Practice Address - Street 1:339 S KENNETH PL
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-4645
Practice Address - Country:US
Practice Address - Phone:480-766-9342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN209965163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine