Healthcare Provider Details

I. General information

NPI: 1598743072
Provider Name (Legal Business Name): SHARON OLSON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1312 HWY 49 NW
BEULAH ND
58523
US

IV. Provider business mailing address

6225 4TH ST NW
BEULAH ND
58523-9487
US

V. Phone/Fax

Practice location:
  • Phone: 701-873-4445
  • Fax: 701-873-4199
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR21752
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: