Healthcare Provider Details

I. General information

NPI: 1023509684
Provider Name (Legal Business Name): TAMMY LYN OLSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2018
Last Update Date: 05/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6022 COUNTY ROAD P
CROSS PLAINS WI
53528-9736
US

IV. Provider business mailing address

6022 COUNTY ROAD P
CROSS PLAINS WI
53528-9736
US

V. Phone/Fax

Practice location:
  • Phone: 608-826-0515
  • Fax:
Mailing address:
  • Phone: 608-826-0515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number123982-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: