Healthcare Provider Details

I. General information

NPI: 1760810493
Provider Name (Legal Business Name): STEPHANIE OLSON PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE BERGMAN

II. Dates (important events)

Enumeration Date: 10/15/2013
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

194 PROGRESS WAY
SPICER MN
56288-5000
US

IV. Provider business mailing address

194 PROGRESS WAY
SPICER MN
56288-5000
US

V. Phone/Fax

Practice location:
  • Phone: 320-640-2891
  • Fax: 320-640-2842
Mailing address:
  • Phone: 320-640-2891
  • Fax: 320-640-2842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2013018075
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: