Healthcare Provider Details

I. General information

NPI: 1023060852
Provider Name (Legal Business Name): MAXINE LAMAE OLSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40520 CO HWY 34 WHITE EARTH HEALTH CENTER
OGEMA MN
56569
US

IV. Provider business mailing address

PO BOX 371 202 N SUNSET AVE
BAGLEY MN
56621
US

V. Phone/Fax

Practice location:
  • Phone: 218-983-4300
  • Fax: 218-983-6217
Mailing address:
  • Phone: 218-694-2285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR1223802
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberR12233802
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License NumberR1223802
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: