Individual provider Active NPI

Brandice Olsen

  • Certified Registered Nurse Anesthetist
  • Anchorage, AK
National Provider Identifier
1104196351
Registry record updated Feb 16, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
432 Issued in AK
Practice address
4100 Lake Otis Pkwy
Suite 222
Anchorage, AK 99508-5229
Phone
(907) 550-6100
Fax
(907) 550-6268
NPI assigned
Jan 5, 2012
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 16, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X 201140700RN OR
Certified Registered Nurse Anesthetist 367500000X 432 AK Primary

Addresses

Primary practice location

4100 Lake Otis Pkwy
Suite 222
Anchorage, AK 99508-5229

Mailing address

14700 28TH Ave N
Suite 20
Plymouth, MN 55447-4835
Phone (763) 559-3779

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AK

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140422000431 AK Practitioner - Certified Registered Nurse Anesthetist (Crna) 8527290733 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
432AKMDPhysical Therapist
201140700RNORMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Chugach Anesthesia, LLC CurrentSince Feb 17, 2014 Accepting new patients
New Frontier Anesthesia, LLC CurrentSince Jan 1, 2024 Accepting new patients
Alaska Spine Center, LLC Past Accepting new patients
Alaska Surgery Center, Limited Partnership Past Accepting new patients

Locations

1230 Northway Dr
Anchorage, AK 99508
Phone (907) 550-6100

4100 Lake Otis Pkwy
Ste 212
Anchorage, AK 99508
Phone (907) 550-6100

4100 Lake Otis Pkwy
Ste 222
Anchorage, AK 99508
Phone (907) 550-6100

4001 Laurel St
Ste A
Anchorage, AK 99508
Phone (907) 563-1800

14700 28th Ave N
Ste 20
Plymouth, MN 55447
Phone (612) 559-3779

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1325721600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1392508800000",
    "number": "1104196351",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14700 28TH AVE N",
            "address_2": "SUITE 20",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554474835",
            "telephone_number": "763-559-3779",
            "fax_number": "763-450-3986"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4100 LAKE OTIS PKWY",
            "address_2": "SUITE 222",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995085229",
            "telephone_number": "907-550-6100",
            "fax_number": "907-550-6268"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLSEN",
        "first_name": "BRANDICE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-01-05",
        "last_updated": "2014-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "OR",
            "license": "201140700RN",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "AK",
            "license": "432",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Anchorage, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.