Healthcare Provider Details

I. General information

NPI: 1902696768
Provider Name (Legal Business Name): RUTHIE OLSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MRS. LILLIAN R OLSON

II. Dates (important events)

Enumeration Date: 05/07/2025
Last Update Date: 05/07/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 FRANCISCAN WAY
MICHIGAN CITY IN
46360-0033
US

IV. Provider business mailing address

51 NORTHVIEW DR
VALPARAISO IN
46383-3015
US

V. Phone/Fax

Practice location:
  • Phone: 219-879-8511
  • Fax:
Mailing address:
  • Phone: 773-951-8564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28253529A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: