Healthcare Provider Details

I. General information

NPI: 1356998629
Provider Name (Legal Business Name): RONETTE OLSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2019
Last Update Date: 08/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2617 FLORIDA ST NE
ALBUQUERQUE NM
87110-3361
US

IV. Provider business mailing address

2617 FLORIDA ST NE
ALBUQUERQUE NM
87110-3361
US

V. Phone/Fax

Practice location:
  • Phone: 505-688-7251
  • Fax:
Mailing address:
  • Phone: 505-688-7251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: