MEDICARE: SUSAN VICTORIA OLSON-SMITH RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WS0200X	School Registered Nurse	R16722	NM

General Provider Information

NPI Number	:	1174177208
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN VICTORIA OLSON-SMITH RN

Provider Business Mailing Address
First Line	:	5145 E 5TH ST
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85711-2327
Country	:	US
Telephone Number	:	520-232-7014
Fax Number	:

Provider Business Practice Location Address
First Line	:	5145 E 5TH ST
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85711-2327
Country	:	US
Telephone Number	:	520-232-7014
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2019
Last Update Date	:	07/26/2019

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