Healthcare Provider Details

I. General information

NPI: 1033993555
Provider Name (Legal Business Name): BOBBI JEAN OLSON CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BOBBI JEAN SMITH

II. Dates (important events)

Enumeration Date: 08/24/2023
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 GOLF COURSE RD
GRAND RAPIDS MN
55744-8648
US

IV. Provider business mailing address

1601 GOLF COURSE RD
GRAND RAPIDS MN
55744-8648
US

V. Phone/Fax

Practice location:
  • Phone: 218-326-3401
  • Fax:
Mailing address:
  • Phone: 218-326-3401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10386
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: