MEDICARE: DEBORAH KAY OLSON CPNP

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	363LP0200X	Pediatric Nurse Practitioner	20061275	MN

General Provider Information

NPI Number	:	1639274822
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORAH KAY OLSON CPNP

Provider Business Mailing Address
First Line	:	6033 ELLIOT AVE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55417-3153
Country	:	US
Telephone Number	:	612-869-8820
Fax Number	:

Provider Business Practice Location Address
First Line	:	425 20TH AVE S
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55454-4400
Country	:	US
Telephone Number	:	612-332-4973
Fax Number	:	612-371-0289

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

Provider Enumeration Date	:	09/13/2006
Last Update Date	:	07/08/2007

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