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General NPI Number Information
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NPI Number | 1487618062
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Entity Type | Individual
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Provider Name | ANGELA SUZZANNE OLOMON DO, FACN
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Gender | Female
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Dates
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Enumeration Date | 04/12/2006
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Last Update Date | 07/23/2025
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Provider Practice Location Address
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Address Line | 900 E SAN MARTIN ST
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City | BOLIVAR
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State | MO
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Zip | 65613-2893
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Country | US
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Telephone | 417-326-7272
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Fax | 417-326-2193
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Provider Business Mailing Address
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Address Line | PO BOX 49
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City | BOLIVAR
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State | MO
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Zip | 65613-0049
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Country | US
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Telephone | 417-326-7272
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Fax | 417-326-2193
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | R1J41
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License Number State | MO
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