Healthcare Provider Details

I. General information

NPI: 1558244012
Provider Name (Legal Business Name): MELISSA OLSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2025
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 S KINDERHOOK AVE
SIOUX FALLS SD
57106-5410
US

IV. Provider business mailing address

1500 S KINDERHOOK AVE
SIOUX FALLS SD
57106-5410
US

V. Phone/Fax

Practice location:
  • Phone: 605-360-6597
  • Fax:
Mailing address:
  • Phone: 605-360-6597
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License NumberR034079
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: