Healthcare Provider Details

I. General information

NPI: 1124913223
Provider Name (Legal Business Name): SUSAN OLSON CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2025
Last Update Date: 07/02/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 1ST AVE SE
WATERTOWN SD
57201-4402
US

IV. Provider business mailing address

PO BOX 1210
WATERTOWN SD
57201-6210
US

V. Phone/Fax

Practice location:
  • Phone: 605-886-8482
  • Fax:
Mailing address:
  • Phone: 605-882-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1972904
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR060447
License Number StateSD
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number12986
License Number StateMN
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCP003705
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: