=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265479299
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SARA M OLSON NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/31/2006
-----------------------------------------------------
Last Update Date | 01/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2660 PRAIRIE LAKE RD
-----------------------------------------------------
City | TOMAHAWK
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54487-8881
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-966-0855
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2660 PRAIRIE LAKE RD
-----------------------------------------------------
City | TOMAHAWK
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54487-8881
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-966-0855
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 838
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 838
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------