Healthcare Provider Details

I. General information

NPI: 1336185776
Provider Name (Legal Business Name): JULIE A OLSON PA-C, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 03/18/2022
Certification Date: 03/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1282 WALNUT ST
DAWSON MN
56232-2333
US

IV. Provider business mailing address

1282 WALNUT ST
DAWSON MN
56232-2333
US

V. Phone/Fax

Practice location:
  • Phone: 320-769-4323
  • Fax: 320-769-2972
Mailing address:
  • Phone: 320-769-4323
  • Fax: 320-769-2972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number11253
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1805
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: