Healthcare Provider Details

I. General information

NPI: 1841457389
Provider Name (Legal Business Name): BRETTA M OLSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRETTA MAY SCHUMACHER MD

II. Dates (important events)

Enumeration Date: 05/21/2008
Last Update Date: 06/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MAC LN
PIERRE SD
57501
US

IV. Provider business mailing address

100 MAC LANE AVERA MEDICAL GROUP PIERRE
PIERRE SD
57501
US

V. Phone/Fax

Practice location:
  • Phone: 605-224-5901
  • Fax: 605-945-5295
Mailing address:
  • Phone: 605-945-5246
  • Fax: 605-945-5295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number1844
License Number StateSD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier6702620
Identifier TypeMEDICAID
Identifier StateSD
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: