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General NPI Number Information
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NPI Number | 1760070841
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Entity Type | Individual
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Provider Name | DENISE OLSON FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 01/05/2021
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Last Update Date | 10/05/2021
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Provider Practice Location Address
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Address Line | 401 PRAIRIE AVE SW
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City | DE SMET
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State | SD
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Zip | 57231-2333
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Country | US
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Telephone | 605-854-3455
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Fax |
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Provider Business Mailing Address
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Address Line | 709 4TH ST SE
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City | LAKE PRESTON
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State | SD
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Zip | 57249-2116
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Country | US
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Telephone | 605-847-4484
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | CP001929
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License Number State | SD
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