Healthcare Provider Details

I. General information

NPI: 1104052992
Provider Name (Legal Business Name): CYNTHIA MAE OLSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2009
Last Update Date: 04/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

174 S RIVERWALK
RIVER FALLS WI
54022-3309
US

IV. Provider business mailing address

808 MILITARY RD
ROTHSCHILD WI
54474-1528
US

V. Phone/Fax

Practice location:
  • Phone: 715-425-8003
  • Fax:
Mailing address:
  • Phone: 715-359-9132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number161774-030
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: