MEDICARE: RICHARD ALLEN OLSON CRNA

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	367500000X	Certified Registered Nurse Anesthetist	96219	MN

General Provider Information

NPI Number	:	1336145093
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD ALLEN OLSON CRNA

Provider Business Mailing Address
First Line	:	210 W GRANT ST
Second Line	:	APT 614
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55403-2246
Country	:	US
Telephone Number	:	612-332-1948
Fax Number	:

Provider Business Practice Location Address
First Line	:	210 W GRANT ST
Second Line	:	APT 614
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55403-2246
Country	:	US
Telephone Number	:	612-332-1948
Fax Number	:

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

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	07/08/2007

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