Healthcare Provider Details

I. General information

NPI: 1760070841
Provider Name (Legal Business Name): DENISE OLSON FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2021
Last Update Date: 10/05/2021
Certification Date: 10/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 PRAIRIE AVE SW
DE SMET SD
57231-2333
US

IV. Provider business mailing address

709 4TH ST SE
LAKE PRESTON SD
57249-2116
US

V. Phone/Fax

Practice location:
  • Phone: 605-854-3455
  • Fax:
Mailing address:
  • Phone: 605-847-4484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberCP001929
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: