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General NPI Number Information
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NPI Number | 1609365501
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Entity Type | Individual
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Provider Name | TY CONRAD OLSON
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Gender | Male
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Dates
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Enumeration Date | 05/07/2018
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Last Update Date | 11/10/2025
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Provider Practice Location Address
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Address Line | MSC10 5610
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City | ALBUQUERQUE
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State | NM
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Zip | 81731
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Country | US
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Telephone | 505-272-4161
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Fax | 505-272-2776
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Provider Business Mailing Address
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Address Line | 1701 W CHARLESTON BLVD STE 400
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City | LAS VEGAS
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State | NV
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Zip | 89102-2320
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Country | US
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Telephone |
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Fax |
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | MD2024-0401
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License Number State | NM
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