MEDICARE: BRENDA KAY OLSON CRNP

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
1	363LF0000X	Family Nurse Practitioner	1-083007	AL

General Provider Information

NPI Number	:	1366675993
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENDA KAY OLSON CRNP

Provider Business Mailing Address
First Line	:	2109 PLAZA DEL DIOS
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-3985
Country	:	US
Telephone Number	:	702-339-7160
Fax Number	:	954-923-1299

Provider Business Practice Location Address
First Line	:	2109 PLAZA DEL DIOS
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-3985
Country	:	US
Telephone Number	:	702-339-7160
Fax Number	:	954-923-1299

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2009
Last Update Date	:	11/18/2016

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