MEDICARE: ANNE COURTNEY OLSON

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	347C00000X	Private Vehicle	FKP 5750	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	08020736	OTHER	TX	DRIVER'S LICENSE

General Provider Information

NPI Number	:	1780066712
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNE COURTNEY OLSON

Provider Business Mailing Address
First Line	:	4105 TUCSON DR
Second Line	:
City	:	AMARILLO
State	:	TX
Zip	:	79109-5530
Country	:	US
Telephone Number	:	806-356-0747
Fax Number	:

Provider Business Practice Location Address
First Line	:	4105 TUCSON DR
Second Line	:
City	:	AMARILLO
State	:	TX
Zip	:	79109-5530
Country	:	US
Telephone Number	:	806-356-0747
Fax Number	:

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

Provider Enumeration Date	:	06/25/2015
Last Update Date	:	06/25/2015

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Directions to “ ANNE COURTNEY OLSON ” Practice Location

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