1255425997 NPI number — SHAWNA NORTH OLSEN M.S.P.T.

Table of content: SHAWNA NORTH OLSEN M.S.P.T. (NPI 1255425997)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255425997 NPI number — SHAWNA NORTH OLSEN M.S.P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OLSEN
Provider First Name:
SHAWNA
Provider Middle Name:
NORTH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.S.P.T.
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:
1255425997
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6979 S HOLLY CIR
Provider Second Line Business Mailing Address:
STE. 105
Provider Business Mailing Address City Name:
CENTENNIAL
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80112-1577
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-694-2295
Provider Business Mailing Address Fax Number:
303-694-1843

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
660 GOLDEN RIDGE RD
Provider Second Line Business Practice Location Address:
STE. 130
Provider Business Practice Location Address City Name:
GOLDEN
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80401-9541
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-275-2190
Provider Business Practice Location Address Fax Number:
303-275-2191
Provider Enumeration Date:
10/03/2006

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: 225100000X , with the licence number:  8020 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 102255327 . This is a "OWCP FACILITY ID" identifier . This identifiers is of the category "OTHER".




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