MEDICARE: MR. CHANCE A OLSEN AA

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	367H00000X	Anesthesiologist Assistant	AA2025-0009	NM

General Provider Information

NPI Number	:	1598588428
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHANCE A OLSEN AA

Provider Business Mailing Address
First Line	:	455 SAINT MICHAELS DR
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87505-7601
Country	:	US
Telephone Number	:	505-913-3361
Fax Number	:

Provider Business Practice Location Address
First Line	:	455 SAINT MICHAELS DR
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87505-7601
Country	:	US
Telephone Number	:	505-913-3361
Fax Number	:

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

Provider Enumeration Date	:	11/07/2024
Last Update Date	:	06/01/2026

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