Healthcare Provider Details

I. General information

NPI: 1760913628
Provider Name (Legal Business Name): NORA L OLSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2017
Last Update Date: 10/12/2021
Certification Date: 10/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 E DIVISION ST
FOND DU LAC WI
54935-4560
US

IV. Provider business mailing address

1808 W BELTLINE HWY SSM HEALTH FDL REGIONAL CLINIC
MADISON WI
53713-2334
US

V. Phone/Fax

Practice location:
  • Phone: 920-926-8424
  • Fax: 920-926-8389
Mailing address:
  • Phone: 920-926-8343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2020014574
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number75475-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: