Healthcare Provider Details

I. General information

NPI: 1598075970
Provider Name (Legal Business Name): MARIBETH OLSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2010
Last Update Date: 08/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 2ND AVE
MADISON MN
56256-1006
US

IV. Provider business mailing address

900 2ND AVE
MADISON MN
56256
US

V. Phone/Fax

Practice location:
  • Phone: 320-598-7536
  • Fax:
Mailing address:
  • Phone: 320-598-7551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number11011
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: