1538204706 NPI number — PATRICIA OLSON MED

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538204706 NPI number — PATRICIA OLSON MED

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

OLSON

Provider First Name:

PATRICIA

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MED

Provider Gender Code:

F

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:

1538204706

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

01/11/2017

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

813 12TH AVE N

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

FARGO

Provider Business Mailing Address State Name:

ND

Provider Business Mailing Address Postal Code:

58102-2625

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

1201 25TH ST S

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

FARGO

Provider Business Practice Location Address State Name:

ND

Provider Business Practice Location Address Postal Code:

58103-2311

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

701-451-4900

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

02/21/2007

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 101YP2500X , with the licence number:  00154 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 101YP2500X , with the licence number: 327-8-1-95-93 , registered in the state of ND ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 58103-003A . This is a "9400692" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
• Identifier: 9400692 . This is a "PHCS" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
• Identifier: 6575850 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
• Identifier: 137157 . This is a "TRIWEST" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
• Identifier: 62-67338 . This is a "MEDICA UBH" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
• Identifier: 2327563 . This is a "AMERICA'S PPO" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
• Identifier: 990991045437 . This is a "BHP PREFERRED 1" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
• Identifier: 18051 . This is a "BCBSND" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
• Identifier: HP52676 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
• Identifier: 309S90L . This is a "BCBSMN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".