Healthcare Provider Details

I. General information

NPI: 1295738789
Provider Name (Legal Business Name): SUSAN KAY OLSON CNP/PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 11/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 KANSAS AVE SE
HURON SD
57350-2522
US

IV. Provider business mailing address

PO BOX 1411
HURON SD
57350-1411
US

V. Phone/Fax

Practice location:
  • Phone: 605-352-8767
  • Fax: 605-352-8784
Mailing address:
  • Phone: 605-352-8767
  • Fax: 605-352-8784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCP000049
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0625
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: