1164674354 NPI number — MS. SANDRA LEA OLSON RN

Table of content: MS. SANDRA LEA OLSON RN (NPI 1164674354)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164674354 NPI number — MS. SANDRA LEA OLSON RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OLSON
Provider First Name:
SANDRA
Provider Middle Name:
LEA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
RN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164674354
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/21/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2442
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLSTRIP
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59323-2442
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-748-3423
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 CHEYENNE AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAME DEER
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59043-0070
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-477-4474
Provider Business Practice Location Address Fax Number:
406-477-8848
Provider Enumeration Date:
10/21/2008

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: 163W00000X , with the licence number:  RN24877 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: RN24877 . This is a "NURSING LICENSE" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".




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