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NPI Code Detail

MEDICARE: MR. DEAN OLSEN

MEDICARE: MR. DEAN OLSEN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1172V00000XCommunity Health Worker

General Provider Information

NPI Number : 1144946278
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DEAN OLSEN
Provider Business Mailing Address
First Line : 855 E 4800 S STE 100
Second Line :
City : MURRAY
State : UT
Zip : 84107-5513
Country : US
Telephone Number : 385-707-5345
Fax Number :
Provider Business Practice Location Address
First Line : 855 E 4800 S STE 100
Second Line :
City : MURRAY
State : UT
Zip : 84107-5513
Country : US
Telephone Number : 385-707-5345
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/19/2022
Last Update Date : 10/19/2022

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Directions to “ MR. DEAN OLSEN ” Practice Location

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