Healthcare Provider Details
I. General information
NPI: 1528094943
Provider Name (Legal Business Name): HEIDI M OLSON-FITZGERALD PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 06/25/2006
Last Update Date: 07/25/2025
Certification Date: 07/25/2025
Deactivation Date:
Reactivation Date:
III. Provider practice location address
1800 21ST AVE S
FARGO ND
58103-5759
US
IV. Provider business mailing address
PO BOX 3363
OMAHA NE
68103-0363
US
V. Phone/Fax
- Phone: 701-365-8700
- Fax: 701-365-8701
- Phone: 701-356-5503
- Fax: 701-364-9781
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363A00000X |
| Taxonomy | Physician Assistant |
| License Number | 9250 |
| License Number State | MN |
| # 2 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 363A00000X |
| Taxonomy | Physician Assistant |
| License Number | PAC0178 |
| License Number State | ND |
VII. Legacy identifiers
For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:
| # 1 | |
| Identifier | 07Q72OL |
| Identifier Type | OTHER |
| Identifier State | ND |
| Identifier Issuer | MNBS # |
| # 2 | |
| Identifier | 45G88OL |
| Identifier Type | OTHER |
| Identifier State | ND |
| Identifier Issuer | MNBS # |
| # 3 | |
| Identifier | 73A60OL |
| Identifier Type | OTHER |
| Identifier State | ND |
| Identifier Issuer | MNBS # |
| # 4 | |
| Identifier | 1528094943 |
| Identifier Type | MEDICAID |
| Identifier State | MN |
| Identifier Issuer | |
| # 5 | |
| Identifier | 838S6OL |
| Identifier Type | OTHER |
| Identifier State | MN |
| Identifier Issuer | MNBS # |
| # 6 | |
| Identifier | 752287800 |
| Identifier Type | MEDICAID |
| Identifier State | ND |
| Identifier Issuer | |
| # 7 | |
| Identifier | 0118270 |
| Identifier Type | OTHER |
| Identifier State | ND |
| Identifier Issuer | MEDICA # |
| # 8 | |
| Identifier | 137064 |
| Identifier Type | OTHER |
| Identifier State | ND |
| Identifier Issuer | UCARE # |
| # 9 | |
| Identifier | 0118265 |
| Identifier Type | OTHER |
| Identifier State | ND |
| Identifier Issuer | MEDICA # |
| # 10 | |
| Identifier | 0118267 |
| Identifier Type | OTHER |
| Identifier State | ND |
| Identifier Issuer | MEDICA # |
| # 11 | |
| Identifier | DA9011015571 |
| Identifier Type | OTHER |
| Identifier State | ND |
| Identifier Issuer | PREFERRED ONE # |
| # 12 | |
| Identifier | HP25814 |
| Identifier Type | OTHER |
| Identifier State | ND |
| Identifier Issuer | HEALTHPARTNERS # |
| # 13 | |
| Identifier | 24553 |
| Identifier Type | OTHER |
| Identifier State | ND |
| Identifier Issuer | NDBS # |
| # 14 | |
| Identifier | 975263 |
| Identifier Type | OTHER |
| Identifier State | ND |
| Identifier Issuer | AMERICA'S PPO/ARAZ # |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone:
