Healthcare Provider Details

I. General information

NPI: 1538653225
Provider Name (Legal Business Name): MICHELLE M OLSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2018
Last Update Date: 06/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 5TH ST NW
BEMIDJI MN
56601-2915
US

IV. Provider business mailing address

612 5TH ST NW
BEMIDJI MN
56601-2915
US

V. Phone/Fax

Practice location:
  • Phone: 218-444-4444
  • Fax:
Mailing address:
  • Phone: 218-444-4444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberH-0350
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: